A second service evaluation of remifentanil patient-controlled analgesia usage on labour ward at a district general hospital

 

Background & Aims

Remifentanil is a short-acting, strong µ-opioid. It is rapidly metabolised through non-specific tissue esterases in adults and newborns. Remifentanil patient-controlled analgesia (PCA) is an analgesic option in labour offered by many maternity units in the United Kingdom, but with limited data on usage.

 

The RESPITE trial [1] challenged pethidine as the standard of care for analgesia in labour, with conversion rates to epidural of 41% with pethidine and 19% with remifentanil PCA.

 

Warwick Hospital is a district general hospital with a maternity unit that has ≈3500 births per year. Since 2017, we have offered remifentanil PCA to women in labour.

 

A first service evaluation (2020-2021) highlighted areas for improvement. We increased education across the multi-disciplinary team, incorporated a remifentanil PCA scenario into PROMPT, and attached aide-memoires to every PCA pump. Following these interventions we have now re-evaluated our practice.