What’s Best Analgesia for ECV?

Neuraxial analgesia (epidural or spinal) combined with tocolytic 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 ask about 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. Comparative effectiveness of intravenous remifentanil, epidural anesthesia and a two-step analgesic approach for external cephalic version: a large prospective single-center cohort study. American Journal of Obstetrics & Gynecology, Volume 0, Issue 0

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

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

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