Hospital pioneers drug's use in labour

Katarina Williams | 12th August 2009

Dawne Sharplin Rotorua Hospital has become the first maternity care provider in New Zealand to pioneer the use of a common anaesthetic and sedative as pain relief in childbirth.

Traditionally, Remifentanil hydrochloride, or Ultiva, has been used by anaesthetists through injection to produce or maintain heavy sleep during an operation or to sedate or relieve pain for intensive-care patients.

But thanks to a group of British anaesthetists who brought the drug's novel use with them to their new workplace in Rotorua in 2004, Rotorua Hospital became the first place in New Zealand to formally establish the drug's use for childbirth, says anaesthetic department head Dr Simon Scothern.

"For New Zealand, it's quite innovative," Dr Scothern said of the drug's maternity use over the past two years.

Dawne Sharplin of the Rotorua Midwifery Centre, who has more than a decade's experience, said Ultiva was "a very good drug".

She said about 30 per cent of all first-time mothers under her care had been given it during labour.

Ultiva came from a family of medicines call opioids. But unlike other related drugs such as pethidine - which could produce side effects in the baby - Ultiva could provide fast pain relief and be quickly cleared by the body, meaning little effect on the child, the midwife said.

Because of its short "half-life", one dose of Ultiva could provide relief for about two minutes. "It just stops pain for the length of the contraction and then it's gone.

"It's very, very good for first-timers. It acts quickly and is administered quickly. If we need a woman to push, we need her back with us, so the short half-life helps."

Ultiva can be used with other pain relievers, and patients are able to receive more than one dose of the drug throughout labour.

But it has yet to be registered for labour use. Obstetric input is needed and surgeons need to talk to women about potential risks.

Women must also give consent.

Rotorua Hospital intensive care anaesthetist Ulrike Buehner spoke about Ultiva's use in maternity pain management at the national pain society's annual scientific meeting in Rotorua last month.

REMIFENTANIL HYDROCHLORIDE (ULTIVA) * Used as an alternative to pethidine, which has a similar effect to morphine.

* An audit last year showed 88 per cent of the 144 Rotorua Hospital patients surveyed described it as an excellent or very good method of pain relief during childbirth.

* Side effects, including nausea, itching and sedation, were usually mild and "no more common than other methods of analgesia". Only five of the 144 patients surveyed had reported "severe" side effects.