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Remifentanil-PCA to alleviate labor-pain - a true and safe alternative to epidural labor analgesia?
Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS, 10/19/09

Kranke P et al. – Although remifentanil crosses the placenta, it is eliminated quickly in neonates by rapid metabolism and redistribution. Unfortunately, remifentanil does not have a licence for administration to the pregnant patient, and it is unlikely that the manufacturers would consider the cost justified. However, in labor and pediatric anaesthesia the off–label use of drugs is not uncommon. As it stands remifentanil is the best opioid for obstetric use so far. Therefore it is the onus on us to justify the use of remifentanil as off–label drug for obstetric analgesia on the basis that the benefit outweighs the risk. Proper informed consent, appropriate monitoring for the mother and the newborn, one–to–one nursing or midwifery care as well as the availability of an attending physician experienced in neonatal resuscitation and an anaesthesiologist with experience regarding the use of remifentanil is important to ensure that this method retains its credit for obstetric analgesia. These issues are discussed in an interdisciplinary approach.