Schuurhuis Anke, Roumen Frans J M E, de Boer Josien B
Universitair Medisch Centrum Utrecht, afd. Anesthesiologie, Utrecht, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A551.
The basic principle of the practice guideline 'Pharmaceutical pain treatment during labour' is that during labour every woman can have adequate pain treatment at her request. Most women experience severe pain during labour, but retrospective satisfaction also depends on the support of care-givers and on the extent to which the woman was involved in decisions relating to her situation. A number of medical indications require good pain management. Epidural analgesia is the safest and most effective method, preferably as patient-controlled analgesia (PCA). PCA with remifentanil appears promising, but remains to be adequately investigated. Pethidine is far less effective. Recommended organisational changes include structured provision of information on pharmaceutical pain management in the 30th week of pregnancy, to be developed by midwives, obstetricians and anaesthetists. Other recommended changes include referral to another hospital for the treatment of choice, development of local protocols across primary and secondary care with agreements about out-patient referral to the anaesthetist, structured daily contact between obstetricians and anaesthetists, the time lapse between the request for pain treatment and the administration of the treatment, and the site of administration and monitoring.
《分娩期药物镇痛治疗》实践指南的基本原则是，分娩期间每位女性都可根据自身需求获得充分的疼痛治疗。大多数女性在分娩时会经历剧痛，但回顾性满意度还取决于护理人员的支持以及女性参与与其自身情况相关决策的程度。一些医学指征需要良好的疼痛管理。硬膜外镇痛是最安全、最有效的方法，最好采用患者自控镇痛（PCA）。瑞芬太尼PCA似乎很有前景，但仍有待充分研究。哌替啶的效果要差得多。建议的组织变革包括在妊娠第30周由助产士、产科医生和麻醉师提供有关药物疼痛管理的结构化信息。其他建议的变革包括转诊至另一家医院进行选择的治疗、制定涵盖初级和二级护理的地方协议并就门诊转诊至麻醉师达成一致、产科医生和麻醉师之间进行结构化的日常联系、从提出疼痛治疗请求到实施治疗的时间间隔，以及给药和监测地点。
