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 need iv access.
- The heart sounds of your baby will be monitored by continuous CTG.
- We measure your oxygen saturation and blood pressure continuously. We regularly ask about your pain score (0-10), monitor respiratory and heart rate and temperature.
- It takes about 20 mins to start the pump and another 5-10 mins for optimal pain stilling effect.
- Only you yourself are allowed to press the administration button of the pump.
- The maximum dosage is limited, so that you cannot overdose.
- During the first hour of administration there will be a care provider in your room to monitor the effect of the medication and possible side effects.
Advantages of analgesia with remifentanil
- Easy administration, faster than epidural.
- Takes away the sharp edges of the pain and allows for relaxation in between contractions.
- Can be administered in more advanced labour.
- You can regulate and therefore control the pump administration rate yourself.
- Short duration of action; after stopping the medication is cleared rapidly. The effect and possible side effects of the drug usually wear off within minutes.
- No harmful effects are expected for your baby.
Disadvantages and possible side effects of remifentanil
- You cannot mobilize and will have to stay in bed.
- You will feel the contractions coming and going, but the pain will be more bearable.
- During active pushing the administration of remifentanil will be stopped.
- The fetal heart rate pattern can change because of the medication and become less variable. This is usually temporary and may ask for somewhat more attention from your care provider in the interpretation of the fetal heart sounds.
- Possible side effects are nausea, drowsiness, low blood pressure, respiratory depression and itching.
- Remifentanil cannot be used in case you are allergic or oversensitive to opiate medications or after usage of medication which enhances the effects of remifentanil.
- Long term effects of remifentanil on your baby are as yet unknown but up to date there are no reports of harmful effects.
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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