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Einsatz von 2 %igem hyperbarem Prilocain zur Spinalanästhesie

Sensitivitätsanalyse in der ambulanten Chirurgie

Use of 2 % hyperbaric prilocaine for spinal anesthesia

Sensitivity analysis in outpatient surgery

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Zusammenfassung

Hintergrund

Seit 2 Jahren steht 2 %iges hyperbares Prilocain als Lokalanästhetikum für die Spinalanästhesie in Deutschland zur Verfügung. Es zeichnet sich durch eine kurze Wirkdauer sowie das Fehlen von postspinalem Harnverhalt und geringen transienten neurologischen Syndromen aus. Den pharmakologisch wünschenswerten Eigenschaften für eine ambulante Spinalanästhesie steht aber ein höherer Preis für das Pharmakon im Vergleich zu 0,5 %igem hyperbarem oder isobarem Bupivacain gegenüber.

Material und Methoden

Anhand eines ökonomischen Modells (Sensitivitätsanalyse) wird untersucht, bis zu welcher Aufenthaltsdauer eines Patienten im Aufwachraum (AWR) die pharmakologischen Vorteile einer kurzen Wirksamkeit und von weniger Nebenwirkungen ökonomisch gegenüber dem höheren Präparatepreis überwiegen. Die Sensitivitätsanalyse entstammt der Investitionsrechnung und untersucht, unter welchen Bedingungen eine Investition (Verwendung von 2 %igem hyperbarem Prilocain) ökonomisch sinnvoll ist. Hierzu werden bestimmte Rahmenparameter als fix angenommen und dann in mehreren Modellen verändert. Hieraus lässt sich berechnen, unter welchen Bedingungen der Einsatz z. B. eines teureren Medikaments ökonomisch sinnvoll ist, weil damit andere Kosten gespart werden.

Ergebnisse

Unter deutschen Rahmenbedingungen ergibt sich aus der Sensitivitätsanalyse für die Benutzung von 2 %igem hyperbarem Prilocain bei Spinalanästhesien im Rahmen von ambulanten Narkosen mit einer 60-minütigen Operationszeit ein wirtschaftlicher Vorteil gegenüber 0,5 %igem hyperbarem Bupivacain und gegenüber 0,5 %igem isobarem Bupivacain, wenn die Patienten, die 2 %iges hyperbares Prilocain erhalten haben, nicht länger als ca. 120 min im AWR verbleiben.

Schlussfolgerungen

Die Modellierung prozessorientierter und mit ökonomischen Daten hinterlegter Abläufe in der ambulanten Anästhesie zeigt, dass die Anwendung von 2 %igem hyperbarem Prilocain zur ambulanten Spinalanästhesie das Potenzial besitzt, bei gleichbleibender medizinischer Qualität sinnvoll und effizient zu sein.

Abstract

Background

Hyperbaric prilocaine 2 % has been available for spinal anesthesia in Germany for 2 years and is characterized by a short duration of action, a lack of postspinal urine retention and a reduction of transient neurological syndromes. However, desirable pharmacological properties are contrasted by higher pharmacological costs compared to hyperbaric bupivacaine 0.5 %.

Materials and methods

This paper deals with a sensitivity analysis for the use of hyperbaric prilocaine 2 % versus hyperbaric bupivacaine 0.5 % in Germany and investigates the financial break-even point up to which time a shorter patient stay in the recovery area compensates for the higher costs for the use of prilocaine 2 % for ambulatory spinal aaesthesia. A sensitivity analysis is an instrument of investment appraisal. It is a model to reduce a complex system with numerous variables to a straightforward calculation by assuming a framework requirement and systematically changing only one or two variables. In this paper additional costs for spinal anesthesia have been neglected, only the time a nurse spends with the patient in the recovery area and the costs for each vial of drug have been taken into account.

Results

For the assumption of 75 min time until leaving the recovery area and being discharged after spinal anesthesia with hyperbaric prilocaine 2 % versus 150 min (recovery of motor competence) or 405 min (voiding) with hyperbaric bupivacaine 0.5 % the calculation shows a cost benefit for hyperbaric prilocaine 2 % of EUR 11.64 or EUR 64.76 compared to hyperbaric bupivacaine 0.5 % and EUR 13.32 or EUR 66.44 compared to isobaric bupivacaine 0.5 %. Under the assumption that all patients who have received spinal anesthesia with hyperbaric bupivacaine 0.5 % can be discharged from the recovery area after 150 min, the use of hyperbaric prilocaine 2 % remains more economical as long as the patient is discharged from the recovery area within 130 min. If 405 min recovery time is assumed for hyperbaric bupivacaine 0.5 % the costs compared with hyperbaric prilocaine 2 % will be compensated after 300 min. To be more economical compared to patients with hyperbaric prilocaine 2 % those who received hyperbaric bupivacaine 0.5 % must be discharged from the recovery area within at least 100 min. However, a time of less than 160 min for discharge from the recovery area is not published anywhere in the literature. In summary, the use of hyperbaric prilocaine 2 % for 60 min operation time is cheaper than the use of bupivacaine 0.5 % as long as patients do not stay in the recovery area for longer than 120 min and are discharged from the recovery area.

Conclusions

For German framework conditions the use of hyperbaric prilocaine 2 % can provide an economical advantage compared to the use of hyperbaric bupivacaine 0.5 % if staff assignment can be flexible.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung hin: keine Interessenkonflikte für Dr. Mutz und C.H. Bley. Prof. Vagts hat Vortragshonorare der Firma Sintetica erhalten, sowie nach Einreichen der Publikation durch die Firma Meduna.

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Correspondence to D.A. Vagts MSc. Hospitalmanagement, DEAA, EDIC.

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Vagts, D., Bley, C. & Mutz, C. Einsatz von 2 %igem hyperbarem Prilocain zur Spinalanästhesie. Anaesthesist 62, 271–277 (2013). https://doi.org/10.1007/s00101-013-2159-9

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