Wulf H, Stamer U
Klinik für Anästhesiologie und Operative Intensivmedizin, Christian-Albrechts-Universität zu Kiel.
Anaesthesist. 1998 Sep;47(9):757-64. doi: 10.1007/s001010050623.
Obviously there is a world-wide trend towards regional analgesia for pain relief during delivery. Data on the current practice in Germany are lacking.
In 1996 questionnaires on obstetric anaesthesia and analgesia were mailed to all university departments of anaesthesia.
All 38 university hospitals with obstetric units replied (100%). Mean annual delivery rate was 1156. Epidural analgesia (EA) (n = 22), intramuscular injection of opioids (n = 18), and non-opioids as a suppository (n = 17) were often used for pain relief during labour. Intravenous injections (n = 12) or pudendus anaesthesia (n = 7) were practised as well. Entonox (N2O/O2), paracervical blocks or transcutaneous electrical stimulation (TENS) was rarely used. EA for relief of labour pain was offered in all university hospitals. Twelve of them had an epidural rate of less than 10%, in nine the rate was 10-19%, in eight hospitals 20-29% and 30% or more in nine. Indication for EA was a demand by the parturient (n = 34), by the obstetrician (n = 26) or the midwife (n = 18), predominantly because of prolonged labour (n = 32) or significant pain (n = 21). Half of the university departments used an epidural combination of local anaesthetics (bupivacaine) and opioids (sufentanil (n = 12) and/or fentanyl (n = 9)). In all but one department the application of an epidural catheter was performed by anaesthesiologists exclusively. In some hospitals obstetricians (n = 10) or midwives (n = 4) were allowed to give epidural top-up injections. Of the 38 university departments 11 had an anaesthesiologists on duty 24 h a day responsible for the obstetric unit exclusively.
In 1977, 14 of 18 university departments of anaesthesiology offered epidural analgesia for parturients. This option was available in all university departments in 1996. A mean rate of 10-20% epidurals for vaginal delivery is well within the limits reported from other countries, whereas the rate of regional anaesthesia for scheduled caesarean section (40%) still is rather low in Germany, as reported in part 1 of this survey (Anaesthesist 1998;47:59-63).
显然，分娩时采用区域镇痛以缓解疼痛已成为全球趋势。目前德国的相关实践数据尚缺。
1996年，向所有大学麻醉科邮寄了关于产科麻醉和镇痛的调查问卷。
所有38家设有产科的大学医院均回复（回复率100%）。年平均分娩率为1156例。硬膜外镇痛（EA）（22家）、肌肉注射阿片类药物（18家）和非阿片类栓剂（17家）常用于分娩时的疼痛缓解。也采用静脉注射（12家）或阴部神经麻醉（7家）。恩托诺克斯（N₂O/O₂）、宫颈旁阻滞或经皮电刺激（TENS）很少使用。所有大学医院均提供硬膜外分娩镇痛。其中12家医院的硬膜外镇痛率低于10%，9家为10% - 19%，8家为20% - 29%，9家为30%及以上。硬膜外镇痛的指征是产妇的需求（34家）、产科医生的需求（26家）或助产士的需求（18家），主要原因是产程延长（32家）或疼痛剧烈（21家）。一半的大学科室采用局部麻醉药（布比卡因）和阿片类药物（舒芬太尼（12家）和/或芬太尼（9家））的硬膜外联合用药。除一个科室外，所有科室的硬膜外导管置入均由麻醉医生单独操作。在一些医院，产科医生（10家）或助产士（4家）被允许进行硬膜外追加注射。38个大学科室中有11个科室有麻醉医生24小时专门负责产科病房。
1977年，18个大学麻醉科中有14个为产妇提供硬膜外镇痛。1996年所有大学科室都有此选项。阴道分娩硬膜外镇痛的平均使用率为10% - 20%，完全在其他国家报告的范围内，而德国择期剖宫产的区域麻醉率（40%）仍相当低，本调查的第一部分已有报道（《麻醉医师》1998年；47:59 - 63）。
