Abstract

Background: Patient-controlled intravenous analgesia with remifentanil (RPCA) is increasingly considered as an alternative to epidural analgesia during labor. Its pharmacological profile—ultrashort half-life, rapid metabolism, and ease of titration—offers theoretical advantages in terms of speed, autonomy, and clearance. Nevertheless, questions remain regarding its pharmacodynamic profiles, especially related to its analgesic potential and safety.

Objective: To evaluate whether RPCA is an effective and safe method for intrapartum analgesia.

Methods: A structured PubMed search (2000–2025) yielded 130 articles. After applying predefined selection criteria, 74 studies were included. These comprised randomized controlled trials, systematic reviews, guidelines, and both prospective and retrospective observational studies. Due to heterogeneity in protocols and outcomes, no meta-analysis was performed.

Results: RPCA was more effective than systemic opioids like pethidine in terms of pain relief and maternal satisfaction. Compared to epidural analgesia, RPCA provided less potent pain relief but similar satisfaction in selected patients. Conversion rates to neuraxial techniques ranged from 19% to 41%. Respiratory depression—mostly mild desaturation—was common. Severe maternal complications have been reported, particularly in association with inadequate monitoring or concurrent sedatives. Neonatal outcomes, including Apgar scores and umbilical cord pH, were generally comparable to other analgesic methods.

Conclusion: RPCA provides superior pain relief to systemic opioids and may offer a valuable alternative when neuraxial techniques are not feasible. While less effective than epidural analgesia, it can yield high maternal satisfaction. Respiratory events are common and sometimes severe, requiring strict safety measures including uninterrupted midwifery care, continuous saturation and respiratory monitoring, written protocols, a dedicated IV line, and staff trained in cardiorespiratory resuscitation.