Date of Award

Summer 5-5-2023

Document Type

DNP Project

Project Team Faculty Member

Kevin Stein

Project Team Faculty Member

Rebecca Collier


Remifentanil, patient-controlled analgesia, obstetrics, labor analgesia, parturient


Labor has the potential to be the most excruciating and intense physical pain a woman experiences in her life. Neuraxial anesthesia, which includes epidural, spinal, or combined spinal-epidural technique, is the gold standard for pain control in laboring patients (Lee et al., 2017). Seemingly forgotten, a subset of parturients cannot experience the benefits of neuraxial anesthesia due to several absolute and relative contraindications. These women rely on other options for labor pain control. Remifentanil has emerged as a preferred opioid option for labor and delivery due to its rapid onset (peak effect in 1.1 minutes) and rapid metabolism by non-specific plasma esterases (Glass et al., 1999). The purpose of this project was to educate obstetrical anesthesia providers, obstetricians, residents, and pharmacists at a level 3 perinatal center in Central Illinois on remifentanil patient-controlled analgesia (PCA) for laboring parturients as an alternative to neuraxial analgesia. An evidence-based remifentanil PCA dosing regimen was also recommended. The results of the project implied that there was an increased understanding of remifentanil and an increased buy-in for the implementation of a remifentanil PCA at the facility. A recommendation is to follow up to determine if a remifentanil PCA standardized protocol has been implemented.

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