[Remifentanil during labour; has its place in pain relief during labour been decided?]

Patient-controlled analgesia using remifentanil (remifentanil PCA) has been used as a new form of pain relief during labour since soon after its release on the market. Reduction in pain scores lasts for 1 to 2 hours, and the analgesia is inferior to that of an epidural. Remifentanil PCA can be an alternative for epidural analgesia in cases where the woman cannot or does not want to receive epidural anaesthesia. In some hospitals in the Netherlands remifentanil PCA is being used on a large scale, possibly because of its less invasive character and for logistical reasons. The Netherlands RAVEL study comparing remifentanil with epidural analgesia showed greater satisfaction with pain relief in the epidural group. There is a high risk of hypoventilation during remifentanil PCA use, leading to desaturation; since desaturation can be a late consequence of hypoventilation, adequate monitoring of the woman is essential. It would be ideal to monitor the frequency and depth of ventilation along with peripheral saturation, and one-on-one care of the woman is advised.