Practice variation in the use of remifentanil during labour

An overview of the application in Dutch Hospitals

Geplaatst op

To survey (a) the frequency of the use of remifentanil patient controlled analgesia (PCA) during labour in the Netherlands; (b) considerations of gynaecologists whether or not to offer remifentanil-PCA; (c) target population for remifentanil-PCA and (d) the application of maternal monitoring.

Design: Descriptive survey.

Method: A questionnaire was sent to all 81 Dutch hospitals with a labour ward. The following subjects were covered: (a) available methods for pharmacological pain relief; (b) considerations of gynaecologists whether or not to offer remifentanil-PCA; (c) target population for remifentanil-PCA; (d) maternal monitoring and (e) the hospital’s birth data for the year 2016. The hospital pharmacist was asked for the number of remifentanil ampuls dispensed in 2016-2017.

Results: The questionnaire was completed by 81 gynaecologists (100% response rate). Remifentanil-PCA was available in 59 out of 81 (73%) hospitals with a mean use of 23% of the births (range 16-56%) in those units. In 34 (58%) of these hospitals, remifentanil-PCA is available for all women, and in 25 (42%) it was for a selected group of women. Most frequently mentioned considerations for offering remifentanil-PCA were ‘a need for an alternative for epidural analgesia’ and ‘at the request of pregnant women’ reported a respective 55 (93%) and 46 (78%) times. In hospitals where remifentanil-PCA was not offered, the following motives were given for this policy: ‘epidural analgesia is the best method of pain relief during labour’; ‘risk of serious maternal complication’; and ‘insufficient possibilities for observation at the labour ward’.

Conclusion: A large variation between Dutch hospitals exists in the application of remifentanil-PCA during labour. In the majority of the hospitals, remifentanil-PCA is available for all women. The most common motives mentioned by gynaecologists for its use are ‘a need for an alternative for epidural analgesia’ and ‘at the request of pregnant women’.

Doel

To survey (a) the frequency of the use of remifentanil patient controlled analgesia (PCA) during labour in the Netherlands; (b) considerations of gynaecologists whether or not to offer remifentanil-PCA; (c) target population for remifentanil-PCA and (d) the application of maternal monitoring.

Conclusies

A large variation between Dutch hospitals exists in the application of remifentanil-PCA during labour. In the majority of the hospitals, remifentanil-PCA is available for all women. The most common motives mentioned by gynaecologists for its use are ‘a need for an alternative for epidural analgesia’ and ‘at the request of pregnant women’.

Uitvoerder(s)

SLM. Logtenberg

Contactpersonen

SLM. Logtenberg

Publicaties

Ned Tijdschr Geneeskd. 2018;162(D2816)



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