An Observational Multicentre Study To Analyse The Safety and Effectiveness Of Epidural Analgesia in Labour

View Slides

R. Halliwell ^1,2, P. Gibson^1,2 , D. Elliott ¹, J. Brown ¹, K. Jeffery ¹, L. Cope¹, D. Sy ¹ , S. Pagett ¹ K. Blunden ¹, K. Quill ¹ , P. Klineberg ^1,2
1. Department of Anaesthesia, Westmead Hospital, Westmead, NSW.
2. Department of Anaesthetics, University of Sydney, NSW.

Purpose of Study

To analyse the outcome of a large number of patients having epidural analgesia in labour.

Method

All epidural catheters inserted for analgesia in labour were prospectively recorded using a intranet-based database system. The patients included were those delivering babies at Westmead and Blacktown Hospitals in Sydney. A detailed record of the epidural technique used was collected. All patients were followed up and assessed for complications and patient satisfaction. Data collected included patient demographics, details of epidural insertion technique, initial complications of insertion, serious complications, risk factors (diabetes, malignancy, anticoagulation, immunosupression), patient satisfaction with analgesia, mode of delivery, and dural puncture. Late complications were tracked by giving all patients an information card with a contact phone number. Data was analysed using a statistical program (JMP). Methods included descriptive statistics and exploratory analysis for associations between variables and outcomes. Statistical significance was p < 0.05.

Result

3350 epidurals were inserted by 92 different anaesthetists in the period from May 2005 to February 2007. The experience of operators varied from junior registrar to experienced consultant. The number of epidurals inserted per operator ranged from one to 178. The patient's median age was 29 years (range 14 to 54). The most common indication for epidural insertion was analgesia in 'first stage of labour' (98%). The median satisfaction score (0-10) in first stage of labour was 10 with 10% of women having a score less than 7. Dural puncture rate was 0.7%, unable to establish block 1.9%, bloody tap 5.2%, assisted by senior operator 0.8%. Satisfaction was unrelated to grade of experience/training of operator. Bloody tap rate was significantly higher (9.2%) for consultants who performed less than 30 epidurals per year compared with other operators. Partition analysis showed the most important factors adversely affecting analgesia satisfaction were the occurrence of bloody tap, dural puncture and depth to epidural space greater than 8cm. Probability of dural puncture was significantly greater when the depth to epidural space was greater than 9.5cm. 52% of women who had an epidural had a normal vaginal delivery. Eighteen patients contacted the anaesthetic service for advice following discharge from hospital.

Conclusion

A fully computerised epidural record system provided data for detailed analysis of epidural analgesia in labour. Several factors were found to be related to outcome of epidural analgesia in labour. These include consultants who infrequently perform epidurals, bloody tap, dural puncture and increased depth to epidural space.

Time of Presentation
1030