New fast-acting opioid could be an epidural alternative

“Give me the epidural!” might soon be a saying of the past.

A new fast-acting opioid administered during labor is being flagged as an alternative to epidurals.

The opioid, remifentanil, would be given instead of an epidural, allowing women to be more mobile during labor.

Under new draft guidelines from the UK health body, National Institute for Health and Care Excellence, remifentanil would be given through a tube into the bloodstream and controlled by the woman herself.

According to NICE, it’s a viable option: “For women who want ongoing pain relief during labor and birth but who do not want an epidural.”

An epidural, anesthesia that creates a band of numbness from the belly button to the upper legs, is commonly given during childbirth for pain relief.

It is administrated by an injection in the back and connected with a tube so the woman can self-administer — but there is a limit as to how much pain relief they can have as it’s on a timer.

According to the American Pregnancy Association, more than 50% of women giving birth at hospitals have an epidural.

NICE said the drug can reduce the likelihood of having to use forceps or ventrose during labor and is more likely to have a spontaneous vaginal birth. They also noted women are “less likely to need an epidural if using remifentanil PCA.”

According to the NHS, the new drug is highly effective — kicking in between 20 to 30 seconds after being administered — but wears off after a few minutes, meaning it can be used during contractions until the baby is born.

If a woman has been given remifentanil and decides she wants an epidural instead, she can do so. 

The guidelines warned that overweight patients — those who have a body mass index score of 25 or over — should be aware that they and their baby could face increased risks in labor and should “take this into account when planning their place of birth.”

In the United States, the most common pain management for labor has been narcotics and local anesthetics through an epidural. Recently, there has been a push for using nitrous oxide for pain during labor.

NICE’s draft guidance is being consulted upon until June 6.