REMIFENTANIL ANALGESIA DURING LABOR

Epidural analgesia (EA) is currently considered the gold-standard therapy for labor pain. However, a subset of parturients are ineligible to receive EA, including parturients with coagulopathies, neurologic disorders, and spinal abnormalities. Women with contraindications to EA often receive long-acting systemic opioids, such as meperidine or fentanyl, that risk respiratory depression and sedation in both the mother and the neonate. Remifentanil patient-controlled intravenous analgesia (PCIA) is an alternative analgesic therapy for labor pain.  Unlike most opioids that undergo hepatic metabolism, remifentanil is rapidly metabolized by red blood cell esterases in the blood plasma providing it with an ultra-short acting property (Kranke et al., 2009). This unique feature reduces the accumulation of remifentanil in the plasma after prolonged administration and allows for safer administration closer to the time of delivery. Similar to other opioids, remifentanil can cross the placental barrier and produce fetal and maternal respiratory depression. However, because of its rapid metabolism, remifentanil PCIA reduces the risk of neonatal and maternal respiratory depression when compared to other commonly used opioids (Evron et al., 2005; Kan et al., 1998). The purpose of this project was to assess the safety and efficacy of remifentanil dosing regimens used in current obstetric practice by conducting a comprehensive review of peer-reviewed literature. The specific aim was to use the best available evidence to develop an educational module (EM) to improve knowledge and awareness among anesthesia providers, obstetricians, and obstetric nurses regarding the use of remifentanil in parturients in terms of safety, efficacy, and suggested methods of administration and dosing. A comprehensive literature review was performed to establish an evidenced-based computer-based three-part educational module (EM) with a pre-test and post-test to target healthcare providers managing the care of laboring parturients. The EM content is based on the best available evidence and was designed with input from a panel of experts from California State University Fullerton, Kaiser Permanente School of Anesthesia, and Kaiser Permanente Regional Professional Development and Research.