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Background and Aims Neuroaxial analgesia is the gold standard for pain management during labor, however, in patients with contraindications such as coagulation disorders, the use of systemic opioids is a feasible alternative. Amongst the various opioids used, intravenous patient-controlled analgesia (IPCA) with remifentanil constitutes the best choice given its rapid onset and offset, rapid metabolism and elimination and minimal side effects to the mother and neonate. It’s also associated with high maternal satisfaction.

Results A 33-year-old women, ASA III, 40w+3d of gestation, OI 0000, with immune thrombocytopenic purpura for over 20 years with 50.000 platelets was admitted in the pregnancy ward with strong contractions in early latent phase of labor. Given the contraindication for neuraxial analgesia and after discussion with the patient, it was initiated an IPCA with remifentanil without basal perfusion and with bolus of 0,5 mcg/kg with 3-minute lockout. The patient was monitored with pulse oximeter and capnography, and no episodes of apnea and desaturation were recorded. Fetal cardiotocography showed maintained fetal well-being. For 12 hours labor progressed and cesarian was decided for stationary labor at 6cm. The procedure was done under general anesthesia, without increased blood loss. The puerperium was uneventful. Afterwards, patient satisfaction with labor analgesia was evaluated as better than expected, with mean pain score during labor as 4/10.

Conclusions Remifentanil is a safe and effective alternative to neuraxial analgesia during labor. IPCA is often used, however, more randomized controlled trials are needed to determine the use for basal perfusion and ideal bolus dosage.