Skip to main content

Remifentanil for labor analgesia: a comprehensive review

An Erratum to this article was published on 21 October 2016

Abstract

Japan has seen significant developments in obstetric anesthesia in recent years, including the establishment of the Japanese Society of Obstetric Anesthesia and Perinatology. However, labor pain, which is one of the most important issues in obstetric practice, is still not treated aggressively. The rate of epidural administration for labor analgesia is very low in Japan as compared to other developed countries. Remifentanil has been used for labor analgesia, as part of general anesthesia for cesarean delivery, as well as for various fetal procedures around the world. Intravenous patient-controlled analgesia (IVPCA) with remifentanil is considered to be a reasonable option for labor pain relief. Several studies have demonstrated its efficacy with minimal maternal and neonatal adverse effects. On the other hand, reports of cases of maternal cardiac and respiratory arrest with remifentanil IVPCA within the past couple of years have redirected our attention to its safe use. Remifentanil IVPCA warrants one-to-one nursing monitoring, appropriate education of healthcare providers, continuous maternal oxygen saturation monitoring, end-tidal CO2 monitoring, and availability of both maternal and neonatal resuscitation equipment. This article provides an overview of knowledge and principles of using remifentanil IVPCA for labor analgesia and introduces its potential usage in Japan.

This is a preview of subscription content, access via your institution.

References

  1. Terui K. Comparison of the obstetric anesthesia practice between Japan and USA. Masui. 2009;58(11):1473–5.

    PubMed  Google Scholar 

  2. Devabhakthuni S. Efficacy and safety of remifentanil as an alternative labor analgesic. Clin Med Insights Womens Health. 2013;6:37–49.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rooks JP. Labor pain management other than neuraxial: what do we know and where do we go next? Birth. 2012;39(4):318–22.

    Article  PubMed  Google Scholar 

  4. Lowe NK. The nature of labor pain. Am J Obstet Gynecol. 2002;186(5 (Suppl Nature):S16–24.

    Article  PubMed  Google Scholar 

  5. Pan PH, Eisenach JC. The pain of childbirth and its effects on the mother and the fetus. In: Chestnut DH, Polley L, Tsen LC, Wong CA, editors. Chestnut’s obstetric anesthesia: principles and practice. 4th ed. Philadelphia: Mosby Elsevier; 2009. p. 387–403.

    Chapter  Google Scholar 

  6. Melzack R. The myth of painless childbirth. Pain. 1984;19(4):321–37.

    CAS  Article  PubMed  Google Scholar 

  7. Olufolabi AJ, Booth JV, Wakeling HG, Glass PS, Penning DH, Reynolds JD. A preliminary investigation of remifentanil as a labor analgesic. Anesth Analg. 2000;91(3):606–8.

    CAS  Article  PubMed  Google Scholar 

  8. Kapila A, Glass PS, Jacobs JR, Muir KT, Hermann DJ, Shiraishi M, Howell S, Smith RL. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology. 1995;83(5):968–75.

    CAS  Article  PubMed  Google Scholar 

  9. Thompson JP, Rowbotham DJ. Remifentanil—an opioid for the 21st century. Br J Anaesth. 1996;76(3):341–3.

    CAS  Article  PubMed  Google Scholar 

  10. Douma M. Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. Br J Anaesth. 2010;104(2):209–15.

    CAS  Article  PubMed  Google Scholar 

  11. Marwah R, Hassan S, Carvalho JC, Balki M. Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study. Can J Anesth. 2012;59(3):246–54.

    Article  PubMed  Google Scholar 

  12. Volmanen P, Sarvela J, Akural EI, Raudaskoski T, Korttila K, Alahuhta S. Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: a randomised, controlled, double-blinded study. Acta Anaesthesiol Scand. 2008;52:249–55.

    CAS  Article  PubMed  Google Scholar 

  13. Douma MR, Middeldorp JM, Verwey RA, Dahan A, Stienstra R. A randomised comparison of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour. Int J Obstet Anesth. 2011;20(2):118–23.

    CAS  Article  PubMed  Google Scholar 

  14. Tveit TO, Seiler S, Halvorsen A, Rosland JH. Labour analgesia: a randomised, controlled trial comparing intravenous remifentanil and epidural analgesia with ropivacaine and fentanyl. Eur J Anaesth. 2012;29(3):129–36.

    CAS  Article  Google Scholar 

  15. Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg. 2014;118(3):589–97.

    CAS  Article  PubMed  Google Scholar 

  16. Leong WL, Sng BL, Sia AT. A comparison between remifentanil and meperidine for labor analgesia: a systematic review. Anesth Analg. 2011;113(4):818–25.

    CAS  Article  PubMed  Google Scholar 

  17. Schnabel A, Hahn N, Broscheit J, Muellenbach RM, Rieger L, Roewer N, Kranke P. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol. 2012;29(4):177–85.

    CAS  Article  PubMed  Google Scholar 

  18. Hinova A, Fernando R. Systemic remifentanil for labor analgesia. Anesth Analg. 2009;109(6):1925–9.

    CAS  Article  PubMed  Google Scholar 

  19. Liu ZQ, Chen XB, Li HB, Qiu MT, Duan T. A comparison of remifentanil parturient-controlled intravenous analgesia with epidural analgesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;118(3):598–603.

    CAS  Article  PubMed  Google Scholar 

  20. Stourac P, Suchomelova H, Stodulkova M, Huser M, Krikava I, Janku P, Haklova O, Hakl L, Stoudek R, Gal R, Sevcik P. Comparison of parturient-controlled remifentanil with epidural bupivacaine and sufentanil for labour analgesia: randomised controlled trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012;156:227–32.

    Google Scholar 

  21. Ismail MT, Hassanin MZ. Neuraxial analgesia versus intravenous remifentanil for pain relief in early labor in nulliparous women. Arch Gynecol Obstet. 2012;286:1375–81.

    CAS  Article  PubMed  Google Scholar 

  22. Blair JM, Hill DA, Fee JP. Patient-controlled analgesia for labour using remifentanil: a feasibility study. Br J Anaesth. 2001;87(3):415–20.

    CAS  Article  PubMed  Google Scholar 

  23. Volmanen P, Akural EI, Raudaskoski T, Alahuhta S. Remifentanil in obstetric analgesia: a dose-finding study. Anesth Analg. 2002;94(4):913–7.

    CAS  Article  PubMed  Google Scholar 

  24. Tveit TO, Halvorsen A, Seiler S, Rosland JH. Efficacy and side effects of intravenous remifentanil patient-controlled analgesia used in a stepwise approach for labour: an observational study. Int J Obstet Anesth. 2013;22(1):19–25.

    CAS  Article  PubMed  Google Scholar 

  25. Balki M, Kasodekar S, Dhumne S, Bernstein P, Carvalho JC. Remifentanil patient-controlled analgesia for labour: optimizing drug delivery regimens. Can J Anesth. 2007;54(8):626–33.

    Article  Google Scholar 

  26. D’Onofrio P, Novelli AM, Mecacci F, Scarselli G. The efficacy and safety of continuous intravenous administration of remifentanil for birth pain relief: an open study of 205 parturients. Anesth Analg. 2009;109(6):1922–4.

    Article  CAS  PubMed  Google Scholar 

  27. Shen MK, Wu ZF, Zhu AB, He LL, Shen XF, Yang JJ, Feng SW. Remifentanil for labour analgesia: a double-blinded, randomised controlled trial of maternal and neonatal effects of patient-controlled analgesia versus continuous infusion. Anaesthesia. 2013;68(3):236–44.

    CAS  Article  PubMed  Google Scholar 

  28. Schwarz GL, Volmanen P, Albrechtsen S, Bjoernestad E. Remifentanil target-controlled infusion during second stage labour in high-risk parturients: a case series. Acta Anaesthesiol Scand. 2013;57(6):802–8.

    CAS  Article  PubMed  Google Scholar 

  29. Sia AT, Sng BL, Leo S. Novel vital signs-controlled, patient-assisted intravenous analgesia using remifentanil for labour and delivery. Int J Obstet Anesth. 2014;23(2):196–8.

    CAS  Article  PubMed  Google Scholar 

  30. Bonner JC, McClymont W. Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2012;67(5):538–40.

    CAS  Article  PubMed  Google Scholar 

  31. Marr RHJ, Bythell V. Cardiac arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2013;68(3):283–7.

    CAS  Article  PubMed  Google Scholar 

  32. Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg. 2014;118:589–97.

    CAS  Article  PubMed  Google Scholar 

  33. Konefał H, Jaskot B, Czeszyńska MB, Pastuszka J. Remifentanil patient-controlled analgesia for labor–monitoring of newborn heart rate, blood pressure and oxygen saturation during the first 24 hours after delivery. Arch Med Sci. 2013;9(4):697–702.

    Article  CAS  PubMed  Google Scholar 

  34. Hodnett ED. Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol. 2002;186:S160–72.

    PubMed  Google Scholar 

  35. Volmanen PVE, Akural EI, Raudaskoski T, Ranta P, Tekay A, Ohtonen P, Alahuhta S. Timing of intravenous patient-controlled remifentanil bolus during early labour. Acta Anaesthesiol Scand. 2011;55(4):486–94.

    CAS  Article  PubMed  Google Scholar 

  36. Evron S, Glezerman M, Sadan O, Boaz M, Ezri T. Remifentanil: a novel systemic analgesic for labor pain. Anesth Analg. 2005;100:233–8.

    CAS  Article  PubMed  Google Scholar 

  37. Volikas I, Male D. A comparison of pethidine and remifentanil patient-controlled analgesia in labour. Int J Obstet Anesth. 2001;10:86–90.

    CAS  Article  PubMed  Google Scholar 

  38. Thurlow BA, Laxton CH, Dick A, Waterhouse P, Sherman L, Goodman NW. Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief I labour. Br J Anaesth. 2002;88:374–8.

    CAS  Article  PubMed  Google Scholar 

  39. Volikas I, Butwick A, Wilkinson C, Pleming A, Nicholson G. Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour. Br J Anaesth. 2005;95(4):504–9.

    CAS  Article  PubMed  Google Scholar 

  40. Blair JM, Dobson GT, Hill DA, McCracken GR, Fee JPH. Patient controlled analgesia for labour: a comparison of remifentanil with pethidine. Anaesthesia. 2005;60:22–7.

    CAS  Article  PubMed  Google Scholar 

  41. Thurlow JA, Waterhouse P. Patient-controlled analgesia in labour using remifentanil in two parturients with platelet abnormalities. Br J Anaesth. 2000;84(3):411–3.

    CAS  Article  PubMed  Google Scholar 

  42. Jones R, Pregrum A, Stacey GW. Patient-controlled analgesia using remifentanil in the parturient with thrombocytopaenia. Anaesthesia. 1999;54:459–65.

    Article  Google Scholar 

  43. Balcioglu O, Akin S, Demir S, Aribogan A. Patient-controlled intravenous analgesia with remifentanil in nulliparous subjects in labor. Expert Opin Pharmacother. 2007;8(18):3089–96.

    CAS  Article  PubMed  Google Scholar 

  44. Roelants F, Franceschi ED, Veyckemans F, Lavand’homme P. Patient-controlled intravenous analgesia using remifentanil in the parturient. Can J Anesth. 2001;48(2):175–8.

    CAS  Article  PubMed  Google Scholar 

  45. Owen MD, Poss MJ, Dean LS, Harper MA. Prolonged intravenous remifentanil infusion for labor analgesia. Anesth Analg. 2002;94(4):918–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yayoi Ohashi.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00540-016-2269-z.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ohashi, Y., Baghirzada, L., Sumikura, H. et al. Remifentanil for labor analgesia: a comprehensive review. J Anesth 30, 1020–1030 (2016). https://doi.org/10.1007/s00540-016-2233-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-016-2233-y

Keywords

  • Remifentanil
  • Obstetric anesthesia
  • Labor analgesia