Thread by @OBsleepmerchant

@damien_hug261 updates us on remifentanil PCA for #OBAnes labour analgesia (will actively fight his own bias) - and recognize that people other than #OBAnes are discussing it, so best WE know something as well? #OAA3dc2022

NB topic to remain up to date on, pros & cons exist, and literature has advanced since my first #oaa3dc (2011). OAA #OBAnes WhatsApp poll - 50% routine use, 50% of remainder want to use or extend routine use. Remember 50% don’t have epidural, what are other options?
#OAA3dc2022

@damien_hug261 rightly states that IM pethidine is archaic. Enter remifentanil PCA. But a critical review is promised (without bias or favour - except an occasional opinion) #OAA3dc2022

Safety first! Lots of evidence over the years, @MarcVandeVelde6 @CarolynWeiniger weighed in. Obviously not superior to epidural, but satisfactory analgesia, and apnoea alone not unacceptable #OAA3dc2022

@MarcVandeVelde6 & @CarvalB against routine use of remifentanil - @damien_hug261 respectfully disagrees, pointing to the Belfast experience with remifentanil PCA #OAA3dc2022

However, safety is paramount - 1:1 nursing essential. Not as effective as epidural. Reviews are cautious, siting sparsity and low quality of evidence. Step in RESPITE trial to tackle alternative directly. #OAA3dc2022

Important findings from RESPITE: no difference in incidence of respiratory depression BUT requires 1:1 nursing. Perhaps a bit more evidence for safety, better than pethidine (the enemy), RCT in favour. Several @IJOA_Journal papers 2019 #OAA3dc2022

RemiPCA SAFE database - smaller bolus ranges. No maternal severe adverse events - rare and typically short. 1 cardiac arrest reminds us the importance of 1:1 nursing and careful management of the PCA (like any other) #OAA3dc2022

Routine PCA use examined retrospectively. 1:1 nursing required! Regular training needed. But advocate for remifentanil PCA to be offered routinely #OAA3dc2022

@IJOA_Journal editorial (@CarolynWeiniger) - remifentanil probably best alternative to epidural, choice is valuable but safe practices NB. Critical review includes lived data. Several remifentanil PCA presentations at #oaa2022. Montgomery changes the playing field! #OAA3dc2022

Familiarity may not breed contempt, but possibly safety too? One size does not necessarily fit all, lower doses work too. Maternal choice & informed consent (Montgomery) important. 1:1 remains mandatory. Lower doses in future? #OAA3dc2022

A critical summary from @damien_hug261. Probably worth asking questions if you have them? #OAA3dc2022

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