Geburtshilfliche Analgesie in deutschen Kliniken

Schnabel, Alexander; Hahn, N; Muellenbach, Ralf Michael; Frambach, Torsten; Hoenig, A.; Roewer, Norbert; Kranke, Peter

doi:10.1007/s00101-011-1933-9

Cited by 22 publications

(10 citation statements)

References 30 publications

(32 reference statements)

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“…A survey conducted in Germany only recently suggested that parenteral opioids remain a popular offer for women with labour pain [12]. Despite the fact that all departments responding to the survey provided a 24 h epidural service, “the most commonly used opioids were pethidine (19%), meptazinol (17%) and piritramide (16%) for intermittent intravenous/intramuscular administration” [12]. In case of the use of a PCA device to administer the analgesic, remifentanil was already the most popular choice (68%).…”

Section: Discussionmentioning

confidence: 99%

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Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Kranke

Girard

Lavand’homme

et al. 2013

BMC Pregnancy Childbirth

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BackgroundThe epidural route is still considered the gold standard for labour analgesia, although it is not without serious consequences when incorrect placement goes unrecognized, e.g. in case of intravascular, intrathecal and subdural placements. Until now there has not been a viable alternative to epidural analgesia especially in view of the neonatal outcome and the need for respiratory support when long-acting opioids are used via the parenteral route. Pethidine and meptazinol are far from ideal having been described as providing rather sedation than analgesia, affecting the cardiotocograph (CTG), causing fetal acidosis and having active metabolites with prolonged half-lives especially in the neonate. Despite these obvious shortcomings, intramuscular and intravenously administered pethidine and comparable substances are still frequently used in delivery units.Since the end of the 90ths remifentanil administered in a patient-controlled mode (PCA) had been reported as a useful alternative for labour analgesia in those women who either don’t want, can’t have or don’t need epidural analgesia.DiscussionIn view of the need for conversion to central neuraxial blocks and the analgesic effect remifentanil has been demonstrated to be superior to pethidine. Despite being less effective in terms of the resulting pain scores, clinical studies suggest that the satisfaction with analgesia may be comparable to that obtained with epidural analgesia. Owing to this fact, remifentanil has gained a place in modern labour analgesia in many institutions.However, the fact that remifentanil may cause harm should not be forgotten when the use of this potent mu-agonist is considered for the use in labouring women. In the setting of one-to-one midwifery care, appropriate monitoring and providing that enough experience exists with this potent opioid and the treatment of potential complications, remifentanil PCA is a useful option in addition to epidural analgesia and other central neuraxial blocks. Already described serious consequences should remind us not refer to remifentanil PCA as a “poor man’s epidural” and to safely administer remifentanil with an appropriate indication.SummaryTherefore, the authors conclude that economic considerations and potential cost-savings in conjunction with remifentanil PCA may not be appropriate main endpoints when studying this valuable method for labour analgesia.

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Section: Discussionmentioning

confidence: 99%

“…This is especially true since, at least so far, there seems to be little agreement regarding the necessary monitoring during its use in the labour suite [12]. The latter is true also for other opioids, since these are associated with decreases in oxygen saturation, sedation and the need for oxygen administration as well [42].…”

Section: Discussionmentioning

confidence: 99%

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Kranke

Girard

Lavand’homme

et al. 2013

BMC Pregnancy Childbirth

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“…The latter is currently considered the gold standard for pain relief in labour. The use of patient-controlled intravenous analgesia (i. v. PCA) with remifentanil in obstetrics is relatively new in Germany 4 . Despite the clear benefit of pain reduction, management measures should not interfere with the normal birth process.…”

Section: Introductionmentioning

confidence: 99%

“…Letztere gilt derzeit als der Goldstandard zur Geburtsschmerzlinderung. Relativ neu in Deutschland ist der Einsatz einer patientengesteuerten intravenösen Analgesie (i. v. PCA) mit Remifentanil in der Geburtshilfe 4 . Trotz des klaren Nutzens der Schmerzreduktion sollten steuernde Maßnahmen den physiologischen Ablauf der Geburt nicht beeinträchtigen.…”

Section: Introductionunclassified

Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome

Ortiz

Hammerl

Wasmaier

et al. 2019

Geburtshilfe Frauenheilkd

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Background Various methods of intrapartum analgesia are available these days. Pethidine, meptazinol and epidural analgesia are among the most commonly used techniques. A relatively new one is patient-controlled intravenous analgesia with remifentanil, although the experiences published so far in Germany are limited. Our goal was to study the influence of these analgesic techniques (opioids vs. patient-controlled intravenous analgesia with remifentanil vs. epidural analgesia) on the second stage of labour and on perinatal outcome. Material and Methods We conducted a retrospective study with 254 parturients. The women were divided into 4 groups based on the analgesic technique and matched for parity, maternal age and gestational age (opioids n = 64, patient-controlled intravenous analgesia with remifentanil n = 60, epidural analgesia n = 64, controls without the medicinal products mentioned n = 66). Maternal, fetal and neonatal data were analysed. Results The expulsive stage was prolonged among both primiparas and multiparas with patient-controlled intravenous analgesia with remifentanil (79 [74] vs. 44 [55] min, p = 0.016, and 28 [68] vs. 10 [11] min, p < 0.001, respectively) and epidural analgesia (90 [92] vs. 44 [55] min, p = 0.004, and 22.5 [73] vs. 10 [11] min, p = 0.003, respectively) compared with the controls. The length of the pushing stage was similar among primiparas in all groups but prolonged compared with the controls in multiparas with patient-controlled intravenous analgesia with remifentanil (15 [17] vs. 5 [7] min, p = 0.001) and epidural analgesia (10 [15] vs. 5 [7] min, p = 0.006). The Apgar, umbilical arterial pH and base excess values were similar between the groups, as were the rates of acidosis and neonatal intensive care unit admission. Conclusion Parturients with patient-controlled intravenous analgesia with remifentanil and epidural analgesia showed a prolonged expulsive stage compared with the opioid group and controls. The short-term neonatal outcome was not influenced by the three methods examined.

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“…Data capture for observational studies or registries is often performed in spreadsheet-based applications like Microsoft Excel or directly in statistic software like IBM SPSS [2–5]. In any case, data is transferred into statistic software, such as SAS [6], R [7] or IBM SPSS Statistics [8], for analysis.…”

Section: Introductionmentioning

confidence: 99%

S2O – A software tool for integrating research data from general purpose statistic software into electronic data capture systems

Bruland

Dugas

2017

BMC Med Inform Decis Mak

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BackgroundData capture for clinical registries or pilot studies is often performed in spreadsheet-based applications like Microsoft Excel or IBM SPSS. Usually, data is transferred into statistic software, such as SAS, R or IBM SPSS Statistics, for analyses afterwards. Spreadsheet-based solutions suffer from several drawbacks: It is generally not possible to ensure a sufficient right and role management; it is not traced who has changed data when and why. Therefore, such systems are not able to comply with regulatory requirements for electronic data capture in clinical trials. In contrast, Electronic Data Capture (EDC) software enables a reliable, secure and auditable collection of data. In this regard, most EDC vendors support the CDISC ODM standard to define, communicate and archive clinical trial meta- and patient data. Advantages of EDC systems are support for multi-user and multicenter clinical trials as well as auditable data. Migration from spreadsheet based data collection to EDC systems is labor-intensive and time-consuming at present. Hence, the objectives of this research work are to develop a mapping model and implement a converter between the IBM SPSS and CDISC ODM standard and to evaluate this approach regarding syntactic and semantic correctness.ResultsA mapping model between IBM SPSS and CDISC ODM data structures was developed. SPSS variables and patient values can be mapped and converted into ODM. Statistical and display attributes from SPSS are not corresponding to any ODM elements; study related ODM elements are not available in SPSS. The S2O converting tool was implemented as command-line-tool using the SPSS internal Java plugin. Syntactic and semantic correctness was validated with different ODM tools and reverse transformation from ODM into SPSS format. Clinical data values were also successfully transformed into the ODM structure.ConclusionTransformation between the spreadsheet format IBM SPSS and the ODM standard for definition and exchange of trial data is feasible. S2O facilitates migration from Excel- or SPSS-based data collections towards reliable EDC systems. Thereby, advantages of EDC systems like reliable software architecture for secure and traceable data collection and particularly compliance with regulatory requirements are achievable.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0402-4) contains supplementary material, which is available to authorized users.

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Geburtshilfliche Analgesie in deutschen Kliniken

Cited by 22 publications

References 30 publications

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man’s epidural”

Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome

S2O – A software tool for integrating research data from general purpose statistic software into electronic data capture systems

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