Practice of epidural analgesia for labour pain: a German survey

Abstract

Epidural analgesia is one of the preferred methods of analgesia for labour. The aim of the present survey was to evaluate current practice in obstetric analgesia in departments of anaesthesia and to make a comparison with former surveys from Germany and other countries. Questionnaires on the practice of pain relief, especially epidural analgesia, during labour and delivery were sent to 1178 anaesthetic departments in Germany in the second half of 1996. Five hundred and thirty-two completed replies were received, which represent 46.9% of all German obstetric units. The majority of the departments of anaesthesia practising epidural analgesia have an epidural rate of less than 10% and 10.2% of the departments do not offer this method to their parturients. In 86.8% of all units performing epidural analgesia, the epidural catheter is placed by an anaesthetist. Only 6.5% of the units provide a 24-h epidural service which is exclusively assigned to labour and delivery. In 77.8% of the units, this service is not exclusively assigned to obstetrics, but also to other duties. Of the obstetric units offering epidural analgesia, 14.7% have no epidural service at night. Plain local anaesthetics for epidural analgesia are used by 55.9% of the departments, a combination of local anaesthetics with epidural opioids by 28.7%. Epidural analgesia is predominantly (82.2%) maintained by intermittent bolus administration. Although the rate of epidural analgesia increased during recent decades, this method is not offered to all parturients. Further improvements in the use of epidural analgesia for labour seem to be necessary.

Attitude of obstetricians regarding labour analgesia and limitations in practising it

“…10 Major reasons stated by our participants as limitations in offering epidural labour analgesia are lack of anaesthetists and dependence on anaesthetists which is similar to other studies that have shown unmet need for epidural labor analgesia. 3,11,12 Turkish study has stated that there should be good interpersonal relationship between obstetricians and anaesthetists and there should be mutual respect, understanding and support from professional point of view as their combined management is required for effective labour outcome. 13,14 Our study has shown that non-pharmacological means are the least practised method of labour analgesia.…”

Nemedikamentiniai ir medikamentiniai gimdymo skausmo malšinimo būdai: gimdyvių turimos ir gaunamos žinios bei pasirinkimas

“…Skiriasi žinių lygis skirtingose šalyse, skiriasi ir atliekamos epidurinės analgezijos dažnis: Belgijoje -66,6 proc., Olandijoje -9,6 proc., Lenkijoje -55 proc., Vokietijoje -86,6 proc., Norvegijoje -29,5 proc., Jungtinėje Karalystėje -29,4 proc. [6,[20][21][22][23]. Tuo metu mūsų atlikto tyrimo duomenimis, net 90,4 proc.…”

Analgesie und An�sthesie zur Geburtshilfe in der Schweiz 1999

“…Gesamt <500 Geburten 500-1000 Geburten >1000 Geburten pro Jahr pro Jahr pro Jahr (n=91) [19], unsere Studie erfasste mit 59% aller Geburten eine vergleichbare Zahl für die Schweiz. Die kleinen geburtshilflichen Abteilungen mit einer Geburtenrate <500 Geburten pro Jahr waren mit 60% wie auch schon 1992 am häufigsten vertreten [15].…”

“…Damit entsprach die Praxis der regelmäßigen Verwendung von Opiaten in der Schweiz eher derjenigen von Großbritannien mit 88% [3] als derjenigen Deutschlands mit 28,7% [19]. Damit entsprach die Praxis der regelmäßigen Verwendung von Opiaten in der Schweiz eher derjenigen von Großbritannien mit 88% [3] als derjenigen Deutschlands mit 28,7% [19].…”

“…Bereits 1992 [15] wurde in der Schweiz, im Vergleich mit anderen europäischen Ländern, ein relativ hoher Anteil an Regionalanästhesieverfahren dokumentiert [2,10,16,19,20]. Bereits 1992 [15] wurde in der Schweiz, im Vergleich mit anderen europäischen Ländern, ein relativ hoher Anteil an Regionalanästhesieverfahren dokumentiert [2,10,16,19,20].…”