PARIS – The anesthesiology market in France looks a lot like the patients in this device-intensive area of medical practice – flat and not moving.

While sales hover in a near-comatose state, there is some movement for manufacturers in the slow but steady adoption of local anesthesia and niche products for patient monitoring where there is modest growth.

"The market may be depressed in France, but there is a stability in the sense that we are selling the same number of units as before, just at lower prices." An unnamed product manager with Draeger Medical (Lübeck, Germany) told Medical Device Daily during the recent congress of the French anesthesia society, Société Fran aise d'Anesthésie et de Réanimation (SFAR).

Across the aisle from Draeger in the exhibition space, a manager for GE Healthcare in Versaille, France, who also chose to remain unidentified, agreed with his competitor, saying, "The market is depressed, yes. Is it financially strapped? Yes."

Yet, he added, "There are always the means to buy ... when there is a strong demand for a product," he added indicating a €40,000 GE Logiq ultrasound unit being demonstrated for guiding needles to nerve endings for local anesthesia.

Draeger and GE Healthcare dominate sales for general anesthesia products across Western Europe.

The assessment of market managers from these leading companies is reinforced by a May 2008 report from Frost & Sullivan that predicts anesthesiology device sales in Western Europe will continue to remain stagnant and even see a negative growth rate in some markets until hospitals decide to replace existing systems.

Market growth in Western Europe is severely hindered by stringent cost-cutting measures being adopted by the European governments, said Krishanu Bhattacharjee, a healthcare analyst with Frost & Sullivan.

Bhattacharjee said price sensitivity has become a common challenge for vendors across European markets with the adoption of Diagnosis-Related Groups (DRGs) as a financial tool to control hospital expenditures.

DRGs are now in place in Belgium, Denmark, Italy and Spain and there is increasing pressure in Germany, France and the UK, where the practice will be fully implemented by 2012.

The increasing use of DRGs across the western European countries "is expected to affect unit sales by squeezing the purchasing power of hospitals and hence add to the market stagnation," said Bhattacharjee.

Called Tarification l'Activité (TAA) in France, the Draeger market manager said, "It poses a big question and we do not know what effect this is going to have on the healthcare system."

Slow growth for local anesthesia

There were 7.9 million anesthesia procedures in France in 1997, of which 75% were for general anesthesia, according to a report compiled by SFAR and the prestigious Institut national de la santé et de la recherche médicale (Inserm).

In an interview this year with the lead author of that report, the newspaper Le Monde updated the market figure, estimating the number of procedures had grown to 9 million, an increase of about 1% per year.

Adoption of local anesthesia procedures has grown slowly as well, from the 25% estimated in 1997 to between 30% and 35%, according to an informal polling of a half-dozen companies at the SFAR congress.

"France is in full growth" for ultrasound-assisted local anesthesia, the GE Healthcare manager said during the recent SFAR congress.

The technique developed over the past 20 years for the identification and the subsequent numbing of specific nerves a combination of a needle to deliver a micro-volt shock to the nerve to gauge the response of tissues, and then the injection of the anesthesic agent to the nerve.

"The advantage of echography is that we give the surgeon eyes inside the tissue so they can get rid of electro-shock and stop poking blindly around inside a patient's body with big needles trying to find the nerve," he said.

He said the demand for ultrasound units is strong throughout the country, "not just in Paris but in outpatient polycliniques everywhere."

The pioneer in the field of needles for ultrasound guidance is a small but truly pan-European company, Temena, with headquarters in Aguadulve, Spain, production facilities in Kassel, Germany, and an center in Bondy, France, that supports researchers and clinicians developing techniques for greater precision for both in-plane and out-of-plane injection of anesthesia assisted by ultrasound.

"Echo is the future," said Wilhelm Waskoenig, the CEO and sole proprietor of the company, which will generate 8 million in sales this year.

"General anesthesia will disappear completely at some point," he predicts. "All airway delivery is dead. Peripheral block will overtake this market in a slow, but inevitable process."

"General anesthesia can be fatal for patients, where local is never fatal," he said. "It would require a dozen circumstances to converge to actually kill a patient using local."

Waskoenig introduced the first echogenic anesthesia needles in 1994, treating the surface so that either the tip, the length or both, could be seen in the ultrasound images.

Temena needles are distributed in the U.S. by Stryker (Kalamazoo, Michigan).

The market for peripheral nerve blockage, both with and without electro stimulation, is three million needles each year, "and we hold 10% of that market worldwide."

"We are the leader in local anesthesia needles worldwide, a clear enough statement that you can believe because I am a pharmacist, not a marketing man," he said.

To set a context for this niche, he said the market for epidural needles is between 8 million and 9 million worldwide and here B. Braun Melsungen (Melsungen, Germany) dominates, selling 5 million annually.

For pencil-point needles for spinal anesthesia, more than 10 million units are sold each year.

This peripheral block with a 16% share of annual sales of needles for anesthesia.

"Our biggest markets in Europe are Italy and Switzerland, where there is the highest penetration of nerve-block procedures," Waskoenig said.

As an example of the uneven progress of the procedure in Europe, he said Tenema sells 3,000 peripheral block needles each year to one outpatient clinic in Spain, while a major university hospital in Aachen, Germany, buys just 800 such needles.

"Germany remains the land of general anesthesia," he said, doubting this trend will reverse anytime soon.