Remifentanil Patient-controlled Analgesia (PCA) in Labour–in the Eye of the Storm

Abstract

(Anaesthesia. 2019;74:277–279) A recent study published by Wilson and colleagues in the Lancet has attracted a lot of media attention regarding the use of intravenous remifentanil patient-controlled analgesia (PCA) to replace intramuscular pethidine for labor analgesia. The study reported that the need for conversion to neuraxial analgesia was approximately halved with remifentanil compared with pethidine, and the rate of instrumental delivery was decreased from 26% to 15%. The conclusions of this study contradicted previous recommendations that remifentanil PCA not be considered a standard analgesic option in labor due to safety concerns. This editorial addressed the ramifications of implementing routine remifentanil PCA labor analgesia and the measures that would need to be taken to ensure maternal and neonatal safety.