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Remifentanil PCA (Patient Controlled Analgesia) is a form of effective pain relief during labour. It is offered to women who cannot have an epidural for medical reasons, so you have another choice for pain relief. 

What is remifentanil PCA? 

Remifentanil offers fast, effective and strong pain relief, that is similar to pethidine, but it works more effectively and wears off quickly. 

  • It goes through a drip in your arm. 
  • You press a button to get a small dose when you need it. 
  • This means you control your pain relief. 

Who can use it?

You may be offered remifentanil PCA if you cannot have an epidural because of: 

  • blood clotting problems 
  • certain back surgeries 
  • infection 
  • if an epidural does not work 

An anaesthetist will talk to you about this in clinic or on the labour ward.

When can I start? 

You can start remifentanil PCA on the labour ward when you need stronger pain relief. You can still use: 

  • a TENS machine 
  • gas and air (entonox)

If you had a pethidine injection, you must wait 4 hours before starting remifentanil PCA because side effects are stronger if used too soon. 

How is it given?

  • You will have a drip in your hand and oxygen through soft tubes near your nose. 
  • The anaesthetist sets up a pump with remifentanil. 
  • When you press the button, the medicine is administered. 
  • You feel relief in 30 seconds, strongest at 2–3 minutes, then it wears off. 
  • You can press the button with each contraction. 

You will be monitored carefully: 

  • oxygen levels (with a clip on your finger) 
  • blood pressure 

You can use remifentanil until your baby is born.

How effective is it?

Remifentanil works better than pain injections but not as well as an epidural. 

Are there side effects?

Common side effects: 

  • itching 
  • feeling dizzy or sick 
  • sleepy between contractions 
  • it can slow your breathing or lower oxygen levels, which is why you get oxygen and close monitoring. 

Most side effects are easy to treat.

Is it safe for my baby? 

Yes. Your baby will be monitored all the time while you use remifentanil PCA. Studies show it is safe for babies. It is unlikely to affect how your baby is born, and it is safe to breastfeed afterwards. 

Eating and drinking

When using remifentanil PCA: 

  • Do not eat, but you can drink clear fluids like:  
    • water 
    • clear fruit juice (e.g., Ribena) 
    • isotonic sports drinks 

This helps prevent sickness if you feel sleepy. You will also take omeprazole tablets to reduce stomach acid for safety. 

Can I move around?

You should stay in bed while using remifentanil PCA because it can make you feel dizzy or drowsy.

Safety points

  • The PCA pump gives a safe dose each time you press the button. 
  • After you press, it locks for 2 minutes, then you can press again. 
  • Only you should press the button - not your birth partner or midwife. 

After stopping remifentanil

Remifentanil wears off quickly. You can breastfeed, eat and drink soon after. But do not drive, work, cook, use heavy equipment, or drink alcohol for at least 24 hours after stopping. This may be longer depending on your birth and how you feel - ask your midwife for advice. 

Contact us

If you have any queries relating to this information, please contact the Maternity service.

About this information

Service:
Maternity

Reference:
M/047

Approval date:
1 March 2026

Review date:
1 March 2029

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Important note 

This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.