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Schmerztherapie während der Geburt

Pain therapy during labour

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Zusammenfassung

Der Goldstandard zur effektiven Schmerztherapie während der Geburt stellt die Regionalanalgesie mittels Periduralanalgesie (PDA) dar. Hierbei ist eine intermittierende epidurale Bolusgabe (PIEB) einer kontinuierlichen Applikation des Schmerzmittels hinsichtlich einer besseren Schmerzreduktion, weniger motorischer Blockaden und einer höheren Zufriedenheit der Gebärenden überlegen. Als Alternative zur rückenmarksnahen Nervenblockade bietet sich Remifentanil an, ein Opioid mit kurzer kontextsensitiver Halbwertszeit und somit kurzer Wirkdauer. Die Anwendung sollte aufgrund einer möglichen kardiopulmonalen Depression unter kontinuierlichem Herz-Kreislauf-Monitoring erfolgen. Lachgas wird in englischsprachigen Ländern seit Jahrzehnten angewendet. Allerdings ist Lachgas ein Treibhausgas, und es kann mit Vitamin B12 interagieren. Im deutschsprachigen Raum erfährt Lachgas eine Renaissance zur Therapie von Geburtsschmerzen. Es kann insbesondere zur kurzfristigen Reduktion von Geburtsschmerzen eingesetzt werden. Um der Gebärenden die bestmögliche Schmerztherapie während der Geburt anbieten zu können, sollte ihr in einem multidisziplinären Ansatz mit Geburtshelfern, Hebammen und Anästhesisten frühzeitig ein individuelles Konzept angeboten werden.

Summary

To date the gold standard of treating labour pain is regional analgesia by application of epidural analgesia. When offering epidural analgesia, the programmed intermittent epidural bolus (PIEB) is more effective in terms of pain reduction, less motor blocks and higher satisfaction of the parturient compared to continuous application via perfusor pump. An upcoming alternative to epidural analgesia is remifentanil, a short acting and potent opioid. Remifentanil, however, requires haemodynamic monitoring as cardiac and respiratory impairment has been described. Nitrous oxide has been used for decades in the Anglosphere but it is a greenhouse gas, and interactions with Vitamin B12 are possible. Using novel extraction systems, nitrous oxide has become more attractive for treatment of the initial phase of labour pain in Central Europe. In order to provide the parturient with the best possible and with a tailored pain concept an interdisciplinary approach with obstetricians, midwives and anaesthesiologists is required.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    Stefan Jochberger MD

  2. Universitätsklinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    Clemens Ortner MD &  Klaus Ulrich Klein MD

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  1. Stefan Jochberger MD
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  3. Klaus Ulrich Klein MD
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Correspondence to Stefan Jochberger MD.

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Interessenkonflikt

S. Jochberger erhielt im Juli 2015 von der Firma Smiths Medical ein Honorar im Rahmen einer Pressekonferenz. C. Ortner und K.U. Klein geben an, dass kein Interessenkonflikt besteht.

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Jochberger, S., Ortner, C. & Klein, K.U. Schmerztherapie während der Geburt. Wien Med Wochenschr 167, 368–373 (2017). https://doi.org/10.1007/s10354-017-0571-5

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  • DOI: https://doi.org/10.1007/s10354-017-0571-5

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