Epidural not available - alternative nerve blocker

[Athrawes]

My hospital does not offer epidurals ( even if in screaming ab dabs - although they do them or a spinal block for caeseareans) and instead offer a new drug administered through the hand that they say is better for baby and has less complicated. Starts with R. Apparently blocks pain from
waist down. Anyone know what it is or have experience?

no never heard of that, which country are you in?

I'd love to know how something injected into the hand could anaesthetise from the waist down without affecting the rest of your body?

Awthraws they should have patient information brochures detailing the names of pain relief available and how it can be given.

Is it Remifentanil?

If so it isn't a nerve blocker just an painkiller. It is given to you via a pump which you control yourself (known as a Patient Controlled Analgesia pump - PCA). There has been a lot of interest in it recently as it appears to offer effective analgesia without all the side effects of an epidural.

I've seen it used a few times (locally we use if for people who can't have epidurals) and my impression is that while it can work well it doesn't always(but then so can epidurals). Centres who use it a lot (Belfast springs to mind) seem to get better results than occasional users like us.

There is a bit of information about it on here:
www.royalberkshire.nhs.uk/pdf/Remifentanil%20PCA_mar09.pdf

Professionally I'd be really interested to hear patients experiences of using it - if anyone on here has done so.
Thanks.

Hi Athrawes
Suspect it's remifentanyl.
It's been used successfully in quite a few maternity units as an alternative to epidurals when they are contraindicated or unavailable.

Remifentanyl is a very strong opioid in the same family as diamorphine and pethidine, but it takes less than a minute to work and wears off after 3 minutes, even if you're using it for hours and hours, which makes it safer for the baby, because no hangover effect. It's usually given by PCA pump (patient controlled analgesia) - basically a pump with a button you can push to give yourself a dose as soon as the contraction starts. You use it much the same way as gas and air. It's VERY strong and works well for a lot of people, but it does have side effects of nausea and sedation, just the same as pethidine and diamorphine. It's not a nerve blocker and won't stop you feeling pain, just helps control it. It's not anywhere near the same as an epidural, but is IMO much better than diamorphine/pethidine. At least if you don't get on with it it's easy to try and give up, whereas you can't take diamorphine out.
Hope this helps. (I'm an anaesthetist and have experience of doing both, but not having either yet (38+1)!)

Sorry, cross posted with gasman.

At least we said the same things!

Thanks ladies, I think that is what is offered. I am in New Zealand and will be giving birth at, effectively a cottage hospital. Said hospital is an hour and a half drive down a land slip prone road but still better than a five hour drive over snow capped and often snow blocked mountains. I think this is why the midwives here are so keen on natural pain killer free births - because there ain't much else!
If I do end up using it, the R drug, I will post back my experiences. Six weeks to go.

Good luck Athrawes! Yes post a birth announcement when the time comes