Vovk Racman Pia, Lučovnik Miha, Stopar Pintarič Tatjana
Clinical Department of Anaesthesiology and Intensive Therapy, UMC Ljubljana, 1000 Ljubljana, Slovenia.
Department of Perinatology, Division of Obstetrics and Gynecology, UMC Ljubljana, 1000 Ljubljana, Slovenia.
Medicina (Kaunas). 2025 Aug 29;61(9):1550. doi: 10.3390/medicina61091550.
Remifentanil is a potent opioid characterized by a unique pharmacokinetic profile that makes it well-suited for analgesia in obstetrics. When administered in a patient-controlled analgesia (PCA) modality, remifentanil has become a recognized and versatile alternative for labor pain relief in cases where epidural analgesia is contraindicated or is declined by the parturient. It offers mild to moderate pain relief, effectively decreasing pain from severe levels to a more manageable, moderate intensity. Remifentanil can be administered promptly and acts quickly, making it particularly useful in rapidly progressing or advanced labor. It can also benefit women with anxiety or tokophobia, as its sedative, anxiolytic, and euphoric effects help reduce pain perception and facilitate coping during labor. While it is not superior to epidural analgesia in terms of analgesic efficacy, remifentanil-PCA has obtained a role as a complementary pain-relieving option in several obstetric situations. Remifentanil-PCA is associated with high patient satisfaction, which is closely linked to realistic counseling and proper expectation management. The safety profile for both mother and neonate has been established; however, safety depends on cautious incremental dosing tailored to sedation levels, the use of supplemental oxygen, rigorous monitoring, and avoiding background infusion. Vigilant supervision by healthcare providers is essential, ideally supported by the continuous presence of an anesthesia team in the labor ward.
瑞芬太尼是一种强效阿片类药物，其独特的药代动力学特征使其非常适合用于产科镇痛。当以患者自控镇痛（PCA）模式给药时，在硬膜外镇痛禁忌或产妇拒绝硬膜外镇痛的情况下，瑞芬太尼已成为公认的、用途广泛的分娩疼痛缓解替代方法。它能提供轻度至中度的疼痛缓解，有效将疼痛从严重程度降至更易于控制的中度强度。瑞芬太尼可以迅速给药且起效快，在产程进展迅速或进入晚期产程时特别有用。它对焦虑或恐惧分娩的女性也有益，因为其镇静、抗焦虑和欣快作用有助于减轻疼痛感知并便于在分娩期间应对。虽然在镇痛效果方面它并不优于硬膜外镇痛，但瑞芬太尼PCA在几种产科情况下已成为一种辅助性的疼痛缓解选择。瑞芬太尼PCA与患者的高满意度相关，这与现实的咨询和适当的期望管理密切相关。已确立了对母亲和新生儿的安全性；然而，安全性取决于根据镇静水平谨慎递增给药、使用补充氧气、严格监测以及避免背景输注。医疗保健提供者的警惕监督至关重要，理想情况下由麻醉团队在产房持续在场提供支持。
