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OBSTETRIC ANESTHESIOLOGY

Systemic Remifentanil for Labor Analgesia

Anelia Hinova, FRCA^*, and Roshan Fernando, FRCA

From the *Department of Anesthesia, St. Mary’s Hospital; and Department of Anesthesia, University College London Hospitals NHS Foundation Trust, London, UK.

Address correspondence and reprint requests to Dr. Roshan Fernando, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK. Address e-mail to r.fernando{at}btinternet.com.

Abstract

There is a need for safe, effective, and easy-to-administer systemic analgesia that ideally has rapid onset and offset, matches the time course of uterine contractions, and does not compromise the fetus. Although neuraxial blockade is the "gold standard" for labor analgesia, systemic analgesia is useful in those cases in which neuraxial analgesia is contraindicated, refused or simply not needed by the parturient, or when skilled anesthesia providers are not available. Because of its unique pharmacologic properties, remifentanil has been investigated, and is used clinically, to provide IV labor analgesia. In this focused review, we summarize the efficacy of remifentanil as a labor analgesic and review the current literature regarding its dose, mode of delivery, safety for the mother and fetus/neonate, as well as the scope for future research.