•Superior analgesia to pethidine but inferior to epidural

•Reduced rates of conversion to epidural compared to pethidine

•Better neonatal outcomes than pethidine and similar Apgar scores to epidural

•Lower rates of instrumental deliveries compared to pethidine and similar modes of delivery compared to epidural

•Higher rates of maternal sedation and respiratory compromise with remifentanil 1

Given the seriousness of the risk of respiratory arrest, the following requirements must be met when using RPCAs:

1:1 midwifery care

Provision for monitoring and treatment of respiratory depression including staff training, availability of oxygen, airway equipment & naloxone, anaesthetic support and neonatologist support

The Royal College of Anaesthetists and Anaesthesia Clinical Accreditation Services require that ‘midwives caring for women receiving remifentanil PCA should be trained specifically in the use of the technique’ 2

The delivery suite at St George’s Hospital uses RPCAs infrequently, (approximately 15-20 per year),  primarily for labourers in whom an epidural is contraindicated or has failed.  However, there is currently no training for the staff on delivery suite on the technique

NICE have recently suggested that RPCAs be offered as a primary alternative to epidural analgesia 3

With the increasing use of RPCAs, we sought to establish multidisciplinary training for delivery suite staff to improve patient safety