Remifentanil patient-controlled intravenous analgesia for twin pregnancy (original) (raw)
2010, International Journal of Obstetric Anesthesia
M any women request analgesia for childbirth. The American College of Obstetricians and Gynecologists recommends that all women should receive pain relief on request. 1 Despite several potential risks and side effects, neuraxial labor analgesia is a very safe and effective method of providing pain relief throughout labor. Some women, however, prefer to avoid neuraxial analgesia and prefer an alternative analgesic technique. In addition, a small minority of parturients has contraindications to the use of neuraxial analgesia and therefore must select an alternate mode of pain relief. Patient-controlled intravenous analgesia (PCIA) with remifentanil has become a popular non-neuraxial, parenteral opioid option during the past 2 decades. In some institutions, it is offered routinely as a first-line strategy for labor analgesia. In other departments and services, it is reserved for the selected group of patients, such as those with contraindications to neuraxial analgesia. Most experience with remifentanil PCIA has been reported from Europe. In the current issue of the Journal, Aaronson et al 2 publish a survey on the use of remifentanil PCIA during labor in academic teaching centers in the United States. Slightly more than one-third of responding units reported the use of remifentanil PCIA in the past 12 months. The majority (87%) of institutions offered remifentanil PCIA only when a contraindication for neuraxial analgesia was present, but 13% of centers offered it as an elective alternative to epidural analgesia. Many publications on remifentanil PCIA are available in medical literature. Although the quality of analgesia was the focus of early research, maternal and perinatal safety recently has emerged as an important theme for peripartum remifentanil research. 3,4 The majority of publications are not original peer-reviewed studies but rather reviews,
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