Catheter failure rates and time course with epidural versus combined spinal-epidural analgesia in labor

被引:27
作者
Groden, J. [1 ]
Gonzalez-Fiol, A. [1 ]
Aaronson, J. [1 ]
Sachs, A. [1 ]
Smiley, R. [1 ]
机构
[1] Columbia Univ Coll Phys & Surg, Dept Anesthesiol, 630 West 168th St,PH 5, New York, NY 10032 USA
关键词
Labor analgesia; Epidural; Combined spinal-epidural; Failed analgesia; CESAREAN DELIVERY; EFFICACY;
D O I
10.1016/j.ijoa.2016.01.004
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: The combined spinal-epidural technique for labor analgesia has several advantages over the traditional epidural technique, including faster onset, greater maternal satisfaction, and decreased need for physician boluses. Proponents of the epidural technique criticize the combined spinal-epidural technique, arguing that the epidural catheter remains untested and thus may not be reliable if needed for surgical intervention. We compared failure rates and time of failure between techniques in our tertiary-care academic practice. Methods: Data regarding failed catheters were collected from October 2012 to September 2014 as part of our Quality Assurance program. Failed catheters were defined as any catheter replaced after it was considered to be properly placed and then determined to be intravascular, one sided or resulting in poor maternal analgesia or anesthesia. Results: A total of 5487 analgesics were performed (3980 combined spinal-epidural; 1507 epidural). Eighty-five combined spinal epidural catheters (2.1%) and 59 epidural catheters (3.9%) were replaced during labor (P<0.001). Mean time to replacement was 512 422 min and 354 300 min for the combined spinal-epidural (n=80) and epidural (n=57) groups, respectively (P=0.02). Median time to replacement was 398 [IQR 131-578] min and 281 [IQR 186-767] min for combined spinal-epidural and epidural groups, respectively (P<0.0001). Conclusion: We were able to demonstrate that catheters placed using a combined spinal-epidural technique were less likely to fail during labor and that the time to detection of a failed catheter was significantly longer in the combined spinal-epidural group. Our findings validate the combined spinal-epidural technique as reliable for labor analgesia and tend to refute the theory of the untested catheter. (C) 2016 Elsevier Ltd. All rights reserved.
引用
收藏
页码:4 / 7
页数:4
相关论文
共 11 条
[1]   The safety and efficacy of combined spinal and epidural analgesia/anesthesia (6,002 blocks) in a community hospital [J].
Albright, GA ;
Forster, RM .
REGIONAL ANESTHESIA AND PAIN MEDICINE, 1999, 24 (02) :117-125
[2]   Incidence of epidural catheter replacement in parturients: A retrospective chart review [J].
Eappen, S ;
Blinn, A ;
Segal, S .
INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, 1998, 7 (04) :220-225
[3]   A Randomized Controlled Comparison of Epidural Analgesia and Combined Spinal-Epidural Analgesia in a Private Practice Setting: Pain Scores During First and Second Stages of Labor and at Delivery [J].
Gambling, David ;
Berkowitz, Jonathan ;
Farrell, Thomas R. ;
Pue, Alex ;
Shay, Dennis .
ANESTHESIA AND ANALGESIA, 2013, 116 (03) :636-643
[4]   Failure of Augmentation of Labor Epidural Analgesia for Intrapartum Cesarean Delivery: A Retrospective Review [J].
Lee, Shuying ;
Lew, Eileen ;
Lim, Yvonne ;
Sia, Alex T. .
ANESTHESIA AND ANALGESIA, 2009, 108 (01) :252-254
[5]   Transition from intrathecal analgesia to epidural anesthesia for emergency cesarean section using a combined spinal epidural technique [J].
Mercier, FJ ;
Bouaziz, H ;
Benhamou, D .
ANESTHESIA AND ANALGESIA, 1996, 83 (02) :434-434
[6]   Are combined spinal-epidural catheters reliable? [J].
Norris, MC .
INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, 2000, 9 (01) :3-6
[7]   Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: A retrospective analysis of 19,259 deliveries [J].
Pan, PH ;
Bogard, TD ;
Owen, MD .
INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, 2004, 13 (04) :227-233
[8]  
Preston R, 2007, CAN J ANAESTH, V54, P9, DOI 10.1007/BF03021893
[9]   Epidural catheter function during labor predicts anesthetic efficacy for subsequent cesarean delivery [J].
Riley, ET ;
Papasin, J .
INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, 2002, 11 (02) :81-84
[10]  
Sia A. T., 2003, SMJ Singapore Medical Journal, V44, P464