Remifentanil PCA for women in labour who cannot have an epidural

Patient Information

What is remifentanil PCA?

Remifentanil PCA is the name given to a type of pain relief offered during labour. Remifentanil is a morphine-like drug, which has been shown to be useful in reducing the severity of pain during labour. Although remifentanil cannot provide complete relief of pain, many women find it helpful. Remifentanil is a very short acting drug, which must be given through a pump attached to a dedicated ‘drip’ in your hand or arm. It works very quickly as it is always given directly into the blood and then quickly travels to the brain to give pain relief.

Who can use remifentanil? 

Most women can use a remifentanil PCA for relief of pain during labour. If you have an allergy to morphine-related drugs we would recommend you did not use remifentanil PCA. This type of pain relief is also not suitable if your midwife has given you pethidine within the last 4 hours. Choosing remifentanil PCA does not restrict your choice of additional pain relief in labour. You may use gas and air (Entonox) at any time.

How is it given?

We use a special electronic pump to give remifentanil during labour. This is called a PCA pump (or Patient Controlled Analgesia pump). This is connected to a cannula (“drip”) in your hand or arm. You will be given a button to press, which tells the machine to give you a dose of the medicine. The pain-relieving effect is felt usually in 20 to 30 seconds and wears off again within a few minutes. Press the button at the start or in anticipation of a contraction. It can take some time to learn how to time pressing the button. There is a safety feature built into the pump so that you can only get a safe amount of the drug. You can use the pump at any time right up to your delivery if you wish. The effects will still wear off very quickly when you stop using the pump after your baby has been born.

Are there any unwanted effects of remifentanil?

Remifentanil can make you feel nauseous, dizzy and sleepy, especially between contractions. This will wear off very quickly if you decide to stop using the pump. Remifentanil may also cause the oxygen level in your blood stream to fall and therefore oxygen is given through to all women through nasal prongs. Your midwife will continuously measure your oxygen level using a small peg-like sensor placed your finger. Remifentanil has been shown to be safe for babies, with no other effects seen that don’t already occur with pethidine.

When can I ask for remifentanil?

You can request remifentanil PCA at any time in your labour. Your midwife will call the duty anaesthetist to prepare the pump for you. This may take a few minutes, but once set up it will be ready to use almost immediately. Please ask if you have any questions or worries. Whether you have the remifentanil PCA is your decision, but we will give you as much information as we can to help you to make it.

Originator: R. Pierson. Review date: 05 November 2027. Version: 1.0. DGH ref.: DGH/PIL/02227