Remifentanil for labour analgesia

CONTEXT: Remifentanil is a potent short-acting μ-opioid receptor agonist which is rapidly metabolised in the mother and fetus and may be ideal for labour analgesia. OBJECTIVES: To assess efficacy and safety of remifentanil compared with other analgesic techniques for labour pain. DATA SOURCES: We systematically searched the central register of controlled trials of the Cochrane Library (till August 2011) and MEDLINE (till August 2011). ELIGIBILITY CRITERIA: Randomised controlled trials investigating efficacy and safety of remifentanil administered via a patient-controlled analgesia (PCA) device compared with any other analgesic technique for labour pain were included. RESULTS: We finally included 12 randomised controlled trials (published from 2001 to 2011). Women treated with remifentanil had a lower risk of conversion to epidural analgesia (P < 0.001), a lower mean pain score after 1 h (P < 0.001) and had higher satisfaction scores (P < 0.05) in comparison with women receiving pethidine. Epidural analgesia decreased pain scores compared with remifentanil (P = 0.003). There was only a limited amount of data comparing remifentanil with nitrous oxide or fentanyl. Serious maternal or fetal adverse outcomes were not reported in these trials. CONCLUSION: During labour, remifentanil-PCA provided superior analgesia and higher patient satisfaction compared with pethidine with a comparable degree of adverse events. Epidural analgesia provided superior pain relief in comparison with remifentanil. Due to a low number of reported adverse events, the safety issue of remifentanil use in labour remains an open question that needs to be addressed in future trials.