Current Practice in Obstetric Anesthesia and Analgesia in Public Hospitals of Greece: A 2016 National Survey

Abstract

Aims: This descriptive survey was to evaluate the use of regional anesthesia in obstetrics in Greek public hospitals.Methods: The survey was conducted between March and August 2016. A structured questionnaire was sent to 50 anesthesia departments in Greek public hospitals with obstetric units. Results: The response rate was 94%. Data corresponding to 9475 cesarean and 8155 vaginal deliveries were collected. Regional anesthesia was used in 69.2% of all cesareans, with single shot spinal being the most popular (44.3% of all cesareans). Combined spinal-epidural anesthesia was used in 18.1% of all cesareans (35.1% in hospitals of Athens versus 7.9% outside Athens, p<0.001). Post-cesarean analgesia was applied with simple analgesics and systematic opioids (78.6%). Long-acting spinal opioids were rarely used (4.4% of spinal and spinal/epidurals). Labor epidural analgesia was applied in 19.1% of all vaginal deliveries (30.3% in Athens versus 13.1% outside Athens, p<0.001). Paracetamol and pethidine represented the standard labor analgesics in 48.9% and 55.3% of all hospitals. Intravenous remifentanil was used in 10.6% of hospitals (50% in Athens versus 2.5% outside Athens, p=0.002). In 48.9% of hospitals, mainly outside Athens, the anesthesiologists did not get involved in labor analgesia.Conclusion: Regional anesthesia is the most common practice for cesareans in Greek public hospitals; however, the percentage of general anesthesia remains high. In addition, the use of labor epidural analgesia is limited in hospitals outside Athens.

Keywords

• Analgesia, healthcare, obstetrical, regional anesthesia, survey

References

1. 1. Ranasinghe JS, Birnbach D. Current status of obstetric anaesthesia: improving satisfaction and safety. Indian J Anaesth 2009;53:608-17.
2. 2. Staikou C, Paraskeva A, Karmaniolou I, Mani A, Chondrogiannis K. Current practice in obstetric anesthesia: a 2012 European survey. Minerva Anestesiol 2014;80:347-54.
3. 3. Benhamou D, Bouaziz H, Chassard D, Ducloy JC, Fuzier V, Laffon M, et al. Anaesthetic practices for scheduled caesarean delivery: a 2005 French national survey. Eur J Anaesthesiol 2009;26:694-700.
4. 4. Marcus HE, Behrend A, Schier R, Dagtekin O, Teschendorf P, Böttiger BW, et al. Anesthesiological management of Caesarean sections: nationwide survey in Germany. Anaesthesist 2011;60:916-28.
5. 5. Stourac P, Blaha J, Klozova R, Noskova P, Seidlova D, Brozova L, et al. Anesthesia for cesarean delivery in the Czech Republic: a 2011 national survey. Anesth Analg 2015;120:1303-8.
6. 6. Lai HY, Tsai PS, Fan YC, Huang CJ. Anesthetic practice for Caesarean section and factors influencing anesthesiologists' choice of anesthesia: a population-based study. Acta Anaesthesiol Scand 2014;58:843-50.
7. 7. Stamer UM, Wiese R, Stüber F, Wulf H, Meuser T. Change in anaesthetic practice for Caesarean section in Germany. Acta Anaesthesiol Scand 2005;49:170-6.
8. 8. Juang J, Gabriel RA, Dutton RP, Palanisamy A, Urman RD. Choice of Anesthesia for Cesarean Delivery: An Analysis of the National Anesthesia Clinical Outcomes Registry. Anesth Analg 2017;124:1914-7.

9. 9. Bartusseck E, Fatehi S, Motsch J, Grau T. Survey on practice of regional anaesthesia in Germany, Austria, and Switzerland. Part 3: Methods in obstetric anaesthesia. Anaesthesist 2004;53:993-1000.
10. 10. Zwetsch-Rast G, Schneider MC, Siegemund M. Obstetric analgesia and anesthesia in Switzerland in 1999. Anaesthesist 2002;51:103-9.
11. 11. Meuser T, Wiese R, Molitor D, Grond S, Stamer UM. A survey of labour pain management in Germany. Schmerz 2008;22:184-90.
12. 12. Tveit TO, Halvorsen A, Rosland JH. Analgesia for labour: a survey of Norwegian practice - with a focus on parenteral opioids. Acta Anaesthesiol Scand 2009;53:794-9.
13. 13. Lavand'homme P, Roelants F. Patient-controlled intravenous analgesia as an alternative to epidural analgesia during labor: questioning the use of the short-acting opioid remifentanil. Survey in the French part of Belgium (Wallonia and Brussels). Acta Anaesthesiol Belg 2009;60:75-82.
14. 14. Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. Br J Anaesth 2010;105(Suppl 1):50-60.
15. 15. Loures V, Savoldelli G, Kern K, Haller G. Atypical headache following dural puncture in obstetrics. Int J Obstet Anesth 2014;23:246-52.
16. 16. Kwak KH. Postdural puncture headache. Korean J Anesthesiol 2017;70:136-43.
17. 17. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth 2003;50:460-9.
18. 18. Fincham JE. Response Rates and Responsiveness for Surveys, Standards, and the Journal. Am J Pharm Educ 2008;72:43.
19. 19. Murdoch H, Scrutton M, Laxton CH. Choice of anaesthetic agents for caesarean section: a UK survey of current practice. Int J ObstetAnesth 2013;22:31-5.
20. 20. Hein A, Gillis-Haegerstrand C, Jakobsson JG. Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden. Version 2. F1000Res 2017;6:133.