Remifentanil in labour: retrospective audit of a single regional centre’s outcomes.

Abstract

Background: Remifentanil is a potent short acting opioid which is rapidly metabolised by mother and fetus. Despite positive data published in a meta‐analysis, remifentanil is not used widely in Victoria for labour analgesia. Ballarat Health Services has approximately 1,400 births per annum with Remifentanil being offered as patient controlled analgesia to women in labour. The aim of this retrospective cohort study was to determine the efficacy, patient satisfaction and maternal and neonatal adverse effects profile of remifentanil.

Methods: A retrospective cohort study was conducted over a period of 6 months, from January to June 2018 of all births at a single regional centre. Subjects were identified via routinely collected birth data. Dose of Remifentanil was 20mcg/mL. Four parameters had data collected including maternal demographics, labour, analgesia and neonatal outcomes.

Results: Of 641 births, 45 patients used remifentanil. Patients were 19‐ 40 years old with BMIs of 20‐38 and generally over 37 weeks gestation. 2 patients required Remifentanil for management of a FDIU. 17 patients presented in spontaneous labour with 18 having inductions mainly due to high BMI and GDM. 67% of patient used Nitrous prior to Remifentanil with 18% of patients requiring an epidural. 7% required an instrumental delivery subsequent to remifentanyl. 100% of neonates had a 5‐minute APGAR >6 with 7% requiring a SCN admission and 2% of neonates requiring resuscitation at birth.

Conclusions: This audit indicates that the use of Remifentanil in labour was associated with a high subsequent vaginal delivery rate and no significant adverse neonatal outcomes as a direct result.