Remifentanil - can it be used for pain relief in labour?
What is remifentanil and how does it work to relieve labour pains? Here's what you need to know about the not-so-common drug that's being touted as 'better than pethidine'...
Remifentanil is a drug name we’ve seen pop on forum threads about giving birth all across the web.
Now, thanks to a study of 400 women funded by the National Institute for Health Research, it's being touted as a better pain relief option that pethidine.
But what is it? How does it work? Is it safe to have? Is it the right pain relief option for your labour? And is it really a better choice than pethidine?
Here’s everything you need to know about the use of remifentanil in labour…
What is remifentanil?
Remifentanil is described by the NCT as a “very strong, short-acting painkiller”.
It’s similar to morphine, in that it’s classed as an opioid analgesic drug, and to pethidine, in that it’s a powerful, pain-relieving drug.
However, it’s administered similarly to an epidural. You’re given the drug via a drip in your arm, and you can control the drip using a machine.
How does remifentanil work in labour?
An NHS hospital in Southampton described the process on their website (in 2011) as follows:
“A drip is inserted into a vein in your arm or hand and attached to a patient-controlled analgesia (PCA) pump.
“You press the button on the pump and a small dose of remifentanil is given directly into your vein providing pain relief on demand, reducing the severity of labour pain.
“This starts working within 5 minutes of the drip being connected. You need to press the button every time you have a contraction because each dose of remifentanil wears off within a few minutes.”
Remifentanil actually takes about 10 minutes to clear from the body - unless of course you keep pumping it in.
Who can have remifentanil during labour?
Remifentanil is only available for women who are in established labour and are having hospital births, as the drug needs to be administered by a trained anaesthetist.
It sounds like it’s pretty rare for a hospital to offer it these days - even our GP Dr Philippa Kaye hadn't heard of it - so you should speak to your midwife about your local situation in more detail.
The anaesthetist at your hospital will discuss whether or not it’s an option for you on the day – but:
- if you have severe heart disease
- are allergic to morphine or pethidine
- or have had either morphine or pethidine within the last 4 hours
- it definitely won’t be an option for you.
Is remifentanil effective pain relief?
The NHS has written that it’s not the most effective pain relief, with 1 in 10 women ending up needing an epidural.
Spinals and epidurals are also used if the birth ends up being a C-section. So, it certainly doesn’t sound to us like the miracle pain relief solution you’ve never heard of.
That said, the study by the National Institute for Health Research found women using remifentanil were half as likely (19%) to ask for an epidural than if they were using pethidine (37%).
The study also showed that women using remifentanil rated their pain as 'less severe' than those using pethidine.
As for our MFM forum mums, the few who had used it reported pretty good experiences with it during their own labours.
“Oh my god use it!!!!!!! It was so good! Not many hospitals use it and when I had my little one in March my hospital was the only one in Ireland to have it,” wrote Lampchop26, in 2010.
“You get a button thing which you push when you want it and it's on a 2-min timer so you don't OD [overdose]. I found it worked very, very well.
“There are a couple of downsides, they take it off you when you are pushing, you have to be constantly monitored and it can slow your labour down, which it did for me.
“But it really didn't matter. Even though they take it off you when pushing it didn't make a big difference ‘cause I had enough to keep me going."
“It had to be given to me by an anaesthetist through an IV drip in my arm,” wrote gmac in 2007.
“I was given a 'clicker' and I just clicked every time I felt a contraction starting. It made me feel very relaxed and sleepy during the contraction but then it passed quickly and I felt normal again.
“The amount given with each click is restricted so that you can't overdose. It does seem to be a fairly new drug - maybe it isn't available everywhere. Worth asking about though!”
Is remifentanil safe for me and my baby?
Remifentanil is considered safe for babies - even though the drug ‘passes’ to your unborn baby and can potentially cause slow breathing or drowsiness at birth.
All opioid drugs (including pethidine and morphine) do this, but as remifentanil wears off so quickly, it's still considered safe.
As for mum, you will have your oxygen levels monitored constantly if you take remifentanil, with a peg-clip on your finger, because the drug is also a sedative.
There are also a few possible, common side effects to consider, too.
What are the possible side effects to remifentanil?
All drugs have potential side effects. We've listed some of the possible side effects for remifentanil here, according to the NHS.
Common side effects include:
- slow breathing, with 1 in 2 women needing extra oxygen to breathe
- nausea, vomiting and itching
- drowsiness and dizziness
- having to stop using remifentanil due to low oxygen levels or excessive sleepiness (sedation) occurs in 1 in every 28 women.
Rare side effects include:
- stopping breathing or slow heart rates needing emergency resuscitation: this occurs in less than one in every 2200 women.
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