Labor analgesia in Czech Republic and Slovakia: a 2015 national survey.

BACKGROUND: The purpose of this international survey was to describe the current practices and techniques of labor analgesia in the Czech Republic (CZE) and Slovakia (SVK). METHODS: All Czech and Slovak departments that provide obstetric anesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in detail all peripartum anesthetic procedures delivered by anesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE). RESULTS: The response rate was 71% (70 of 95 departments in CZE, 35 of 54 centers in SVK). Participating centers represented 87.7% of all births in CZE and 66.4% of all births in SVK during the study period. Analgesia for labor, administered by anesthesiologists, was recorded in 12.5% of deliveries (CZE 12.1%, SVK 13.4%). Epidural analgesia was used in most of the cases (CZE 97.2%, SVK 99.1%) whereas spinal (CZE 1.4%, SVK 0.9%) or combined spinal-epidural (CZE 0.5%, SVK 0.0%) and intravenous remifentanil analgesia (CZE 2.4%, SVK 0.0%) were used infrequently. One fifth of the labors with analgesia administered by anesthesiologists (CZE 20.2%, SVK 20.5%) terminated in cesarean section. CONCLUSIONS: Although labor analgesia was available in all Czech and Slovak obstetric centers, only a small proportion of parturients received an effective method of labor pain relief (regional or intravenous analgesia).

[Analgesia for labour in the Czech Republic in the year 2011 from the perspective of OBAAMA-CZ study - prospective national survey]. / Analgezie u porodu v Ceské republice v roce 2011 z pohledu studie OBAAMA-CZ- prospektivní observacní studie.

GOAL OF THE STUDY: The aim of national survey was to describe current practice for analgesia during labour provided by anaesthesiologists in the Czech Republic (CZE). TYPE OF THE STUDY: National prospective observational. SETTING: 49 obstetric departments in CZE. METHODS: We aimed to enrol all 97 obstetric departments in CZE and to monitor every case of anaesthetic care in peripartum period during November 2011. Data were recorded to Case Report Form with two parts (Demography 2010 and Case Report) into TrialDB database (Yale University, USA; adapted IBA, MU, CZE). Demographic data for CZE were obtained on request by ÚZIS. The data were analysed using SPSS 22. RESULTS: We enrolled 1943 cases of anaesthesiological care and 579 (29.8%) of them was to relief labour pain. Population and center weighted estimate of incidence of epidural labour analgesia was 12.5% (95% CI: 10.6% - 14.4%). Epidural analgesia was the most frequently applied via Tuohy needle G18 (97.8%), with administration of an epidural catheter G20 (95.7%), via medial approach (98.8%), in lateral position (76.7%) by the loss of resistance method (94.3%). All administrations of epidural analgesia were started by initial bolus, only in 28.2% of cases were followed continously. Always has been applied mixture of local anaesthetic with sufentanil at a dose of 3-10 mcg. Bupivacaine was most frequently used local anaesthetic (80.7%), followed by levobupivacaine (12.6%). Median concentrations both bupivacaine and levobupivacaine were 0.125% (min. 0.1%, max. 0.3%).The most common complication of epidural analgesia was repeated puncture (21.2%), blood in the catheter (1.4%), blood in the needle (1.2%), unintended puncture of the dura mater (0.7%) and transient paresthesias (0.5%). CONCLUSION: In comparison to previously published data there was trend for lower incidence of epidural analgesia for labour in the CZE.