The purpose of this study was to examine the efficacy of
remifentanil on
external cephalic version (ECV) in
breech presentation. An extensive search was conducted using PubMed, Cochrane Library, and other grey literature. Only randomized controlled trials using
remifentanil for ECV were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes and quality of evidence was assessed using the Risk of Bias and GRADE system. Five studies consisting of 602 patients were analyzed.
Remifentanil resulted in a moderate increase in ECV success rate (RR, 1.19; 95% CI, 1.00 to 1.43; P = .05), a large reduction of
pain score (MD, -2.02; 95% CI, -2.32 to -1.72; P < .00001) with fewer transient fetal
bradycardia (RR, 0.40; 95% CI, 0.19 to 0.85; P = .02). However,
remifentanil did not affect
cesarean section rates, (RR, 0.97; 95% CI, 0.49 to 1.93; P = .93) instrumental delivery (RR, 0.94; 95% CI, 0.41 to 2.15; P = 0.89), and spontaneous delivery rate (RR, 1.02; 95% CI, 0.78 to 1.35; P = 0.87). Mothers treated with
remifentanil have a higher patient satisfaction score. The use of
remifentanil may be a good strategy for ECV. However, extrapolation of this finding to clinical settings must consider the study limitations.