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Geburtshilfe Frauenheilkd 2016; 76(09): 964-971
DOI: 10.1055/s-0042-111009
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Efficacy and Effects of Parenteral Pethidine or Meptazinol and Regional Analgesia for Pain Relief during Delivery. A Comparative Observational Study

Effektivität und Auswirkungen von parenteralem Pethidin oder Meptazinol und Regionalanalgesie zur Schmerzlinderung unter der Geburt. Eine vergleichende Beobachtungsstudie
J. Singer
1   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
,
A. Jank
2   Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
,
S. Amara
2   Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
,
P. D. H. Stepan
2   Department of Obstetrics, University Hospital of Leipzig, Leipzig, Germany
,
U. Kaisers
1   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
,
C. Hoehne
1   Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
› Author Affiliations
Further Information

Publication History

received 24 August 2015
revised 13 May 2016

accepted 22 June 2016

Publication Date:
22 September 2016 (online)

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Abstract

Background: Peripartum anesthesia may consist of parenteral opioids and/or regional analgesia. There is only limited data in the literature comparing both methods in daily obstetric practice. This observational study investigated the opioids pethidine and meptazinol as well as regional analgesics with regard to their administration, efficacy, side effects and subjective maternal satisfaction with therapy. The rates of secondary regional analgesia administration after administration of the respective opioid served as a means of evaluating treatment.

Methods: This study collected data on pain management during vaginal delivery in a German university hospital over a twelve month period. Severity of pain was measured intrapartum using a numerical rating scale. Maternal, neonatal and delivery-related data were obtained postpartum from the clinical records and from the mothers using a questionnaire.

Results: The study is based on data obtained from 449 deliveries. Pain relief achieved by the administration of pethidine and meptazinol was similarly low; maternal satisfaction with the respective therapy was high. Meptazinol was usually administered intravenously (83 % vs. 6 %; p < 0.001), repeatedly (27 % vs. 6 %; p < 0.001) and closer to the birth (1.9 ± 2.7 h vs. 2.6 ± 2.8 h; p < 0.05) compared to pethidine. Secondary regional analgesia was more common after the administration of pethidine (16 % vs. 8 %; p < 0.05). Regional analgesia resulted in greater pain relief compared to opioid therapy (78 % vs. 24 % after 30 min; p < 0.001) and was associated with longer times to delivery (7.6 ± 2.5 h vs. 5.7 ± 2.5 h; p < 0.001) and higher levels of maternal satisfaction with therapy (6.1 ± 1.2 vs. 4.8 ± 1.6 on a 7-point scale; p < 0.001).

Conclusion: In daily clinical practice, meptazinol can be adapted more readily to changes during birth and requires less secondary analgesia. Regional neuraxial analgesia was found to be an efficacious and safe way of managing labor pain.

Zusammenfassung

Hintergrund: Parenterale Opioide und Regionalanalgesie stellen mögliche peripartale Analgesiemethoden dar. In der Literatur liegen wenige Daten zum Vergleich der beiden Verfahren im geburtshilflichen Alltag vor. Diese Beobachtungsstudie untersucht die Opioide Pethidin und Meptazinol sowie Regionalanalgesie hinsichtlich Handhabung, Effektivität, Nebenwirkungen und subjektiver maternaler Therapiezufriedenheit. Die Rate sekundärer Regionalanalgesien nach jeweiliger Opioidgabe dient der Therapiebeurteilung.

Methoden: Im 12-monatigen Studienzeitraum wurden Daten vaginaler Geburten mit entsprechenden Schmerztherapien an einem deutschen Universitätsklinikum erfasst. Die intrapartale Schmerzstärke wurde mittels numerischer Ratingskala gemessen. Mutter-, kind- und geburtsbezogene Daten wurden postpartal aus der klinischen Dokumentation und von den Müttern anhand eines Fragebogens erhoben.

Ergebnisse: Die Studie umfasst Daten von 449 Entbindungen. Die Schmerzlinderung durch Pethidin und Meptazinol ist vergleichbar gering, die maternale Therapiezufriedenheit jeweils gut. Meptazinol wird häufiger intravenös (83 vs. 6 %; p < 0,001) und repetitiv (27 vs. 6 %; p < 0,001) sowie in geringerem Abstand zur Geburt verabreicht (1,9 ± 2,7 h vs. 2,6 ± 2,8 h; p < 0,05) als Pethidin. Sekundäre Regionalanalgesien sind häufiger nach Pethidingabe (16 vs. 8 %; p < 0,05). Regionalanalgesie bewirkt eine stärkere Schmerzlinderung als Opioidtherapie (78 vs. 24 % nach 30 min; p < 0,001) bei längerem Geburtsverlauf (7,6 ± 2,5 h vs. 5,7 ± 2,5 h; p < 0,001) und höherer maternaler Therapiezufriedenheit (6,1 ± 1,2 vs. 4,8 ± 1,6 auf einer 7-Punkte-Skala; p < 0,001).

Schlussfolgerung: Im klinischen Alltag kann Meptazinol besser an den Geburtsverlauf adaptiert werden und macht weniger sekundäre Regionalanalgesien notwendig. Regionalanalgesie zeigt sich in der Praxis als effektive und sichere Wehenschmerztherapie.

Key words

regional anesthesia - obstetrics - pain therapy

Schlüsselwörter

Regionalanästhesie - Geburtsanalgesie - Geburtshilfe - Schmerztherapie

Supporting Information

 

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