Patient-controlled analgesia in labour using remifentanil in two parturients with platelet abnormalities

Two term parturients with documented platelet abnormalities presented to the delivery suite in labour. Because regional analgesic techniques were contraindicated, we elected to use patient-controlled i.v. remifentanil for pain relief. The patient-controlled analgesia (PCA) device was programmed to give a bolus dose of remifentanil 20 micrograms over 20 s with a lockout time of 3 min, and no background infusion. Analgesia was reported as very good by the mothers and by the attending midwives. There were no adverse neonatal sequelae. If there are facilities to monitor the neonate and mother, this method of analgesia may prove useful in those patients where regional techniques are not possible, but further research is needed to ascertain its safety and appropriateness in such circumstances.