# Labour pain relief - remifentanil?



## Guest (Nov 19, 2008)

Hi there

Just wondered if anyone had heard of a labour drug called remifentanil? A girl at my NCT class has told me a lot about it and it sounds good - all the benefits of pethidine without the side effects (doesn't pass to baby) and all the benefits of epidural without slowing down labour and numbness so less risk of tearing. Just wondered if anyone had any experiences of it, good or bad, and what the current thinking is?

Have also posted this on peer support - sorry for duplication but wan't sure where best to post.

Thanks
Perky
xx


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## Mrs CW (Jul 12, 2004)

I'm moving your post to ask a pharmacist as you've had no replies here  

Claire x


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## mazv (Jul 31, 2006)

Hi Perky,

Remifentanil is an opioid drug similar to morphine and pethidine. Personally I haven't heard of it being used in labour but from its pharamcology it does clear from the body much quicker than pethidine so I can see why it might have advantages. It does cross the placenta very easily though so does pass to the baby but the baby can also clear it from the body quickly so this is why it may have less noticeable effects. Not convinced about the statement 'pethidine without the side effects'   All opiate drugs have side effects.

Just looked up the medical literature and found a few papers and trials looking at remifentanil in labour, using as a PCA bolus injection (patient presses a button that delivers a small dose by injection every 2 minutes), as an epidural and during general anaesthesia. Main side effect appears to be reduction of oxygen levels in the mother but this is similar to those experienced with pethidine. As an epidural agent it appears to be better in terms of side effects in the baby after delivery (compared to other opiates- fentanyl and alfentanil)

Remifentanil is way more expensive than pethidine so I'm assuming that this is why it isn't standard practice in maternity units, also it isn't licensed for use in pregnancy (but then most drugs aren't). Looks like there is a lot of interest in using remifentanil due to quicker action and clearance from both mother and baby however it isn't widely used as yet (still appears to be work ongoing looking at establishing the best dose regime for pain relief).

Hope this is useful; but don't be surprised if your local NHS unit doesn't use this during labour  .

Maz x


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