Remifentanil for labour analgesia

Labour pain is considered as severe pain. Epidural analgesia is the most effective and a preferred method of labour analgesia. Remifentanil patient-controlled analgesia (PCA) is an alternative to epidural analgesia when not available, not desired or contraindicated. Remifentanil -a synthetic opioid- is associated with hypoventilation and respiratory depression but the frequency of serious maternal and neonatal adverse events is unknown. This thesis provides information to make a thorough decision on the place of remifentanil-PCA as an appropriate method for pain relief during labour. We conducted a randomised controlled equivalence trial in which we compared satisfaction with pain relief between epidural analgesia and remifentanil-PCA. In secondary analyses we studied the association between fear of childbirth and pharmacological pain relief and whether we could identify women with a request for pain relief who would be as satisfied with remifentanil-PCA compared to epidural analgesia. Afterwards we assessed the current use of remifentanil-PCA and the number of serious adverse events (SAE) attributed to remifentanil-PCA in The Netherlands. We concluded that remifentanil-PCA is used on a large scale in The Netherlands despite lower satisfaction with pain relief compared to epidural analgesia. Although we showed that the risk for an SAE is extremely low, the adherence to strict maternal monitoring and attendance of trained healthcare providers are essential to safely use remifentanil-PCA. To guarantee safe administration of remifentanil-PCA, compliance to the Standard Operating Procedure and maternal monitoring methods have to be improved. If these conditions are met remifentanil-PCA could be an appropriate method for labour analgesia.