What’s Best Analgesia for ECV?

Neuraxial analgesia (epidural or spinal) combined withtocolytic therapy is the pain control method that best increases the success rate of external cephalic version (ECV), according to the ACOG’s PB 221. However, some patients may be reluctant to use regional anesthesia and may askabout IV analgesia. A new study in the AJOG (released as an ePub on March 5, 2026) provides some insights that may be helpful for patient consultation. These investigators compared the success of external cephalic version, modes of delivery, maternal pain, and complications using three strategies: intravenous analgesia with remifentanil, epidural anesthesia, and a stepwise approach in which epidural anesthesia was administered only if intravenous analgesia was unsuccessful. Listen in for details.

1. ACOG PB 221

2. Aiartzaguena, Amaia et al. Comparativeeffectiveness of intravenous remifentanil, epidural anesthesia and a two-stepanalgesic approach for external cephalic version: a large prospectivesingle-center cohort study. American Journal of Obstetrics & Gynecology,Volume 0, Issue 0

3. Hao Q, Hu Y, Zhang L, et a l. A SystematicReview and Meta-Analysis of Clinical Trials of Neuraxial, Intravenous, andInhalational Anesthesia for External Cephalic Version. Anesthesia andAnalgesia. 2020.

4. Wilson MJA, MacArthur C, Hewitt CA, et al.

5. Intravenous Remifentanil Patient-ControlledAnalgesia Versus Intramuscular Pethidine for Pain Relief in Labour (RESPITE):An Open-Label, Multicentre, Randomised Controlled Trial. Lancet. 2018.