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Geburtshilfliche Analgesie in deutschen Kliniken

Remifentanil als Alternative zur Regionalanalgesie

Obstetric analgesia in German clinics

Remifentanil as alternative to regional analgesia

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Zusammenfassung

Hintergrund

Im Rahmen dieser Studie wurde die aktuelle Verwendung i.v.-verabreichter Opioide – unter besonderer Berücksichtigung von Remifentanil als patientenkontrollierte intravenöse Analgesie („patient controlled intravenous analgesia“, PCIA) – in der Geburtshilfe deutscher Kliniken untersucht.

Material und Methoden

Ein Fragebogen wurde an 930 anästhesiologische Kliniken versandt. In dem zweiseitigen Fragebogen wurde nach Geburtenzahl, den alternativ zur Periduralanalgesie (PDA) verwendeten Methoden der geburtshilflichen Analgesie wie z. B. periodisch i.v.-verabreichten Opioiden, PCIA-Techniken bzw. alternativen Verfahren gefragt. Weiterhin zielten die Fragen auf Details bezüglich der Verwendung einer PCIA ab. Die Daten wurden mithilfe der Statistik-Software PASW Statistics 18.0 erfasst und ausgewertet.

Studienergebnisse

Es antworteten 343 anästhesiologische Kliniken (Rücklaufquote: 37%). Über eine Geburtshilfestation verfügten 281 Kliniken. Alle Kliniken boten einen 24-stündigen anästhesiologischen Bereitschaftsdienst zur Durchführung einer PDA an. Die meistverwendeten periodisch i.v.- oder i.m.-verabreichten Opioide waren Pethidin (19%), Meptazinol (17%) und Piritramid (16%). Nur 22 Kliniken (8%) boten eine PCIA als Alternative an; hierbei war Remifentanil (68%) das am häufigsten genutzte Opioid. Für letzteren Fall gaben die meisten Befragten an, die Sauerstoffsättigung (91%) und den Blutdruck (95%) zu überwachen, während das EKG (18%) und die Atemfrequenz (19%) der Mutter weitaus seltener kontrolliert wurden.

Schlussfolgerung

Diese aktuelle Umfrage zeigt, dass Pethidin, Meptazinol und Piritramid die gebräuchlichsten Analgetika für eine opioidbasierte Therapie des Wehenschmerzes sind. Eine PCIA – in den meisten Fällen mit Remifentanil – bieten hingegen nur sehr wenige Kliniken an. Weiterhin weisen die Ergebnisse darauf hin, dass die aktuellen Überwachungsstandards in den Kliniken, die eine PCIA im Rahmen der Geburtshilfe an bieten, verbesserungswürdig sind.

Abstract

Objective

Epidural regional analgesia is still recommended as the gold standard for obstetric analgesia due to its high efficacy and less depressing effects to the central nervous system. However, if absolute or relative contraindications for a regional anesthetic technique are present, there is a need for an effective and safe alternative. This survey investigates the current use of intravenous opioids, with a focus on remifentanil as patient-controlled intravenous analgesia (PCIA), in obstetrics in German hospitals.

Methods

A questionnaire was sent to 930 anesthesia units. Data were collected and analyzed using SPSS statistical package (PASW Statistics 18.0). The questionnaire requested statistics on births, the existing alternative labor analgesic techniques, intramuscular or intravenous opioids, PCIA or other options. Furthermore, the questions focused on details regarding the use of intravenous opioids in conjunction with PCIA techniques.

Results

Replies were received from 343 anesthetic departments (response rate 37%) and 281 clinics had an obstetric department and were included for further analysis. All clinics provided a 24 h epidural service and the most commonly used opioids were pethidine (19%), meptazinol (17%) and piritramide (16%) for intermittent intravenous/intramuscular administration. Only 0.9% of the clinics offered nitrous oxide as an alternative analgesic technique and 22 (8%) of the responding anesthetic departments offered PCIA. Remifentanil was the most popular choice in conjunction with PCIA (68%) for labor analgesia. Most hospitals offering PCIA continuously monitor oxygen saturation (91%) and the blood pressure (95%), whereas continuous electrocardiograms (18%) and clinical observation of the respiratory frequency (19%) were less commonly reported. However, most clinics offered one-to-one nursing for the parturient using an opioid PCIA.

Conclusions

This survey revealed that pethidine, meptazinol and piritramide are the most common opioids for opioid-based systemic labor pain relief in Germany. If PCIA is offered, remifentanil is the most popular opioid. However, only a few clinics are routinely using PCIA for obstetric analgesia. Furthermore the study showed that the current monitoring standards seem to have room for improvement with respect to safe administration of an opioid PCIA. The safety standards require continuous observation of the oxygen saturation, the possibility for oxygen supply, one-to-one nursing for a close clinical observation of the mother and the presence of an anesthetist during the initial titration phase to safely apply this technique. Applying these safety standards PCIA may prove a useful alternative for central neuraxial labor analgesia in those women who either do not want, cannot have or do not need epidural analgesia.

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Danksagungen

Die Autoren danken Frau Lisa Kajdi für die engagierte Mitarbeit bei der Durchführung der Umfrage. Den antwortenden Kollegen der befragten anästhesiologischen Abteilungen gilt ebenfalls ihr Dank.

Interessenkonflikt

Diese Studie wurde ohne externe finanzielle Unterstützung und ohne Sponsor durchgeführt. Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Münster, Münster, Deutschland

    A. Schnabel

  2. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    N. Hahn, R. Muellenbach, N. Roewer &  P. Kranke MBA

  3. Frauenklinik, Katholisches Krankenhaus St. Joseph-Stift , Bremen, Deutschland

    T. Frambach

  4. Frauenklinik und Hebammenschule, Universitätsklinikum Würzburg, Würzburg, Deutschland

    A. Hoenig

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  1. A. Schnabel
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  2. N. Hahn
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  3. R. Muellenbach
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  4. T. Frambach
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  5. A. Hoenig
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  6. N. Roewer
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  7. P. Kranke MBA
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Corresponding author

Correspondence to P. Kranke MBA.

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Schnabel, A., Hahn, N., Muellenbach, R. et al. Geburtshilfliche Analgesie in deutschen Kliniken. Anaesthesist 60, 995–1001 (2011). https://doi.org/10.1007/s00101-011-1933-9

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  • DOI: https://doi.org/10.1007/s00101-011-1933-9

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