Remifentanil for pain relief in labour

What is this information about?

This information is about remifentanil given through a pump that you control for pain relief in labour. This is called remifentanil patient-controlled analgesia (PCA). 

It explains:

• what remifentanil PCA is and how it may help with labour pain 
• who may be able to use it 
• how you use the pump and how fast the drug works 
• the unwanted effects and breathing problems that can happen 
• the checks and care you will need 
• when to ask for remifentanil and how the team sets it up. 

Why have I been given this information?

You may need to choose pain relief for labour. Remifentanil may be a pain relief option for you. This Information explains remifentanil PCA, including how it differs from an epidural and other opioid pain relief. It can help you talk with your anaesthetist and obstetric team about the option that best fits your medical and obstetric needs.

What is remifentanil PCA?

Remifentanil is an opioid drug for pain relief. It is like pethidine or morphine, but it starts to work and wears off much faster than these.  

When you press a button on an electronic pump, the pump gives you a small, measured dose through a drip into a vein in your arm. 

Remifentanil can greatly reduce labour pain, but it does not usually take the pain away fully. Most people will still feel their contractions. The contractions should feel less intense and easier to cope with.

Who can use remifentanil PCA?

The team often advises remifentanil PCA for people who cannot have an epidural for medical or technical reasons. It may also suit people who choose not to have an epidural. 

Most people can use remifentanil safely. It may not suit you if you:

• have some existing health conditions 
• are allergic to opioid drugs 
• have used opioid pain relief drugs recently. 

For some people, an epidural may be the preferred type of labour pain relief because of their own medical or obstetric needs. Your anaesthetist and obstetric team can talk with you about the option that best fits your needs. 

How do I use remifentanil PCA?

You will need a small tube called a cannula, or drip, in a vein. This will usually be on the back of your hand or in your arm. The team connects the drip to an electronic pump. When you press the hand-held button, the pump gives you a small, measured dose of remifentanil. 

You will usually feel the pain relief in 40 to 60 seconds. It wears off within a few minutes. You control when you get the drug. You can press the button when you need it, rather than between contractions. 

The pump has safety features that limit how much of the drug you can get. Some people are more sensitive to its effects. This is why the team must check your breathing and oxygen level all the time. 

You can use the pump at any time, up to the birth of your baby if you wish. When you stop using the PCA after your baby is born, the effects will still wear off very fast.

What unwanted effects can remifentanil cause?

Remifentanil may cause: 

• feeling sick (nausea) or being sick (vomiting) 
• itching 
• dizziness 
• sleepiness between contractions 
• slower breathing.

Sleepiness and slower breathing can also happen with similar drugs, such as pethidine and morphine. Even if you feel drowsy, this will wear off very fast after you stop using the pain relief.

How will the team check and care for me?

A midwife will stay with you at all times. They will use a sensor, like a peg, on your finger to check your oxygen level all the time. At set times, the midwife will also check your pain relief and how drowsy you are. 

If your oxygen level is lower than usual, you will need extra oxygen. You will usually get this through a small tube in your nose. The rest of your checks and care will be the same as for any other person on the labour ward. 

Can remifentanil cause breathing problems?

Remifentanil can make you drowsy and slow your breathing. In some cases, this can make your oxygen level fall. This is why the midwife checks your breathing and oxygen level all the time and stays with you. 

If needed, the team will give you oxygen and can lower or pause the dose of remifentanil. 

More serious breathing problems are rare. If we think you have these, we will take simple measures that quickly improve breathing for most people.

What is known about effects on babies?

Research has shown reassuring short-term outcomes for babies exposed to remifentanil during labour. The short-term side effects are similar to those that occur with pethidine or morphine.

When can I ask for remifentanil?

You can ask for remifentanil at any time while you are in labour. It may not be available if the labour ward is very busy. 

Your midwife will contact the anaesthetist on duty to set up the pump. This may take a little while. You can start to use the pump straight away after the team has given you the button to press.

Who should I ask if I have any questions or would like any further information about remifentanil after I have read this information?

Please ask a member of the maternity team.