Remifentanil is a patient-controlled analgesia (PCA). It is a strong morphine-like painkiller that works very quickly and wears off equally as quickly. Although it cannot provide total pain relief it has been shown to significantly reduce pain from contractions.

Remifentanil is given in small doses through a tube placed in one of your veins. The PCA machine contains the remifentanil which is connected to this tube. You will be given a button to hold that, when you press it, will make the PCA pump give you a small amount of remifentanil. The PCA has a timer on it so you cannot give yourself too much of the drug.

Who is suitable for Remifentanil?

Remifentanil is mainly reserved for women who cannot have an epidural. However, if you decide to try the remifentanil and do not like it you can still decide to have an epidural instead if there is no other reason for you not to have one. You can still use  Entonox (Gas & Air) at the same time as the remifentanil. It is not safe to use if you have an allergy or sensitivity to morphine-like drugs, or your anaesthetist or obstetrician advise against it.

How is it used?

You can have the PCA at any time once your midwife has confirmed you are in active labour and your anaesthetist has agreed that it is safe for you to use.
The pain relieving effects happen within 20-30 seconds of pressing the button. You should press the button as soon as you feel a contraction starting. The effects will wear off in minutes. You can continue to use it up till your baby is born.

Are there any side effects with Remifentanil?

Some women do find that the remifentanil has some side effects. These include feeling sleepy, sick or dizzy. You may also feel itchy. However these will rapidly disappear once the drug is stopped. Some women find it slows their breathing and occasionally the amount of oxygen in their blood falls. This is easily treated by giving you oxygen but because of this you will need to have a small clip on your finger while you are using the PCA to monitor your blood oxygen levels.

Remifentanil does cross the placenta to the baby in a similar way to pethidine but, unlike pethidine, any effect wears off much more quickly. This type of pain management has now been used in large numbers of women in labour with no side effects to the baby.