Maternity care: Remifentanil is recommended as alternative to epidural in draft guidance

Women in labour who need ongoing pain relief but do not want an epidural should be offered the option of remifentanil, according to new draft guidance from the National Institute for Health and Care Excellence (NICE).1The fast acting opioid, given through a tube into the bloodstream, is controlled by the woman herself and enables her to be more mobile than with an epidural.Remifentanil is another pain relief option for women during birth. The draft guidance said that Entonox, a 50:50 mix of oxygen and nitrous oxide, should be available in all birth settings. Some hospitals have had to suspend its use temporarily, however, after air quality tests found levels of nitrous oxide that may put midwives and other healthcare workers at risk of harm.2NICE pointed out that intramuscular opioids such as pethidine, diamorphine, and meptazinol are associated with maternal side effects such as nausea and possible effects on the baby…
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