4.11 INTRAVENOUS PATIENT-CONTROLLED ANALGESIA IN LABOUR- MEDICAL

Intravenous and intramuscular opioids are at best of only very modest efficacy in reducing the intensity of pain during labour 1, but do result in clinically meaningful relief for about 30 % of women 2, 3 Patient-controlled intravenous analgesia (PCIA) with opioid is a method that may also produce satisfactory analgesia for a proportion of labouring women. PCIA with remifentanil is more effective and reliable than intramuscular or intravenous morphine and pethidine or nitrous oxide inhalation 4-6. The fetal and neonatal effects of repeated maternal opioid exposure must be considered and staff skilled in neonatal resuscitation available. MEDICAL CONTRAINDICATIONS INCLUDE 1. Allergy to the proposed opioids (usually fentanyl or remifentanil). 2. The presence of clinically significant maternal respiratory depression from previous exposure to opioids and sedatives. INTRAVENOUS PATIENT-CONTROLLED ANALGESIA MANAGEMEN