Remifentanil information card
This is a summary only. Please discuss any questions with your pregnancy care provider.
What is remifentanil?
Remifentanil is a painkiller which is similar to morphine. It is given via an infusion pump. By pressing the button you yourself can control the administration of the drug. Remifentanil is used regularly during operations, but not officially registered for use during labour. Meanwhile in the Netherlands and other countries there is a lot of experience for the intrapartum use of this medicine. Research shows that with careful control of mother and fetus it is a safe option.
Administration of remifentanil
- You will need an IV cannula.
- Your baby's heart rate will be continuously monitored using a CTG (cardiotocography).
- Your blood oxygen level and blood pressure will be continuously monitored. You will regularly be asked to rate your pain on a scale from 0 to 10, and your breathing, pulse and temperature will be monitored.
- It usually takes about 20 minutes to prepare the administration of remifentanil, followed by another 5–10 minutes for the pain relief to reach its optimal effect.
- You are the only person who may press the button to administer remifentanil.
- The maximum dose is limited, which means that you cannot give yourself an overdose.
- During the first hour of administration, a healthcare professional will remain in the room with you to monitor the effect of the pain relief and any possible side effects.
Benefits of analgesia with remifentanil
- It is an easy way to manage pain and can be administered more quickly than an epidural.
- It provides pain relief, takes the sharp edge off contractions and allows you to relax more between contractions.
- It can also be used when labour is more advanced and the cervix is already significantly dilated.
- You control the administration yourself by pressing the button on the infusion pump, allowing you to remain in control.
- It has a short duration of action. Once administration is stopped, the medication wears off quickly, and its effects usually disappear within a few minutes.
- Any possible side effects generally disappear quickly after administration is stopped.
- No harmful effects on the newborn are expected.
Disadvantages and possible side effects of remifentanil
- You will not be able to walk around and will need to remain in bed.
- You will continue to feel the contractions coming and going, but the pain should be much more manageable.
- Administration of remifentanil is stopped during pushing.
- The baby's heart rate may change as a result of the medication, with reduced variability. This is generally temporary and may sometimes require the healthcare professional to pay additional attention when interpreting the baby's heart rate.
- Possible side effects include nausea, drowsiness, a drop in blood pressure, respiratory depression and itching.
- Remifentanil cannot be used if you are hypersensitive to opioids or if you have recently taken medication that may enhance the effects of remifentanil.
- The long-term effects of remifentanil on your baby are not yet known. However, so far there are no indications that its use is harmful.
Type of risk | How often does this happen? | How to treat? |
| Sleepiness/drowsiness | Very often (> 10%) | When very intense: Stop administration remifentanil. |
| Hypotension/ drop in blood pressure | Very often (> 10%) | We can treat this by administering more fluids through infusion. Medication can be administered to raise the blood pressure. When very intense: Stop administration remifentanil. |
| Nausea | Very often (> 10%) | Medication can be administered to reduce the nausea. When very intense: Stop administration remifentanil. |
| Inadequate pain relief | Often (1-10%) | Consider other options for pain relief, for example an epidural. |
| Respiration depression, which means that the breathing slows down or, very exceptionally, stops. | Often (1-10% | It can be required to administer extra oxygen. When very intense: Stop administration remifentanil. |
Itching all over the body.
| Often (1-10%) | Medication can be administered to reduce the itching. When very intense: Stop administration remifentanil. |
| Confusion/ hallucinations | Often (1-10%) | When very intense: Stop administration remifentanil |
| Impaired heartbeat | Often (1-10%) | It can be required to administer extra oxygen. Medication can be administered to facilitate the heartbeat. When very intense: Stop administration remifentanil |
| Allergic reaction | Rarely (< 0,1%) | Stop administration remifentanil. It can be required to administer extra oxygen. Medication can be administered. |
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