///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00

Ethnicity and Epidural Utilization for Labor

Abstract Number: 160
Abstract Type: Original Research

Isaac P Lowenwirt M.D.1 ; Peter A Silverberg M.D.2; Pierre Patricia MSN,RC3; Julia Tai MA4; Skupski W Daniel M.D.5

Introduction: Despite the superiority and availability of epidural analgesia, ethnic disparities in the provision of epidural analgesia exist(1). The aims of this study are to describe: 1) the use of labor epidural analgesia in a multi-ethnic population with prompt and equal access to education and placement of epidural 2) the occurrence of ethnic differences in the medication dosages necessary.

Methods: Prospective cohort study of all women with singleton fetuses in the cephalic presentation delivering at a tertiary center in the most culturally diverse county in the USA(Queens,NY). IRB approval obtained.Exclusion criteria were planned cesarean delivery, malpresentation and multifetal gestation. Patients in active labor were given a choice of parenteral fentanyl, patient controlled epidural analgesia,or no medication. Maternal demographics, obstetrical data and medication dosages were recorded.Severity of pain, efficacy of analgesia and patient satisfaction scores were measured by visual analog scale (VAS).Multiple logistic regression was performed to determine variables that predicted patientschoice of analgesia. Power analysis used ethnic differences in epidural use to show a necessary sample of 800.

Results:Of 800 consecutive patients (comprised of 42.4% Chinese-Korean, 18.8% Hispanic, 12.9% Caucasian, 9.8% African American, 8.4% Indian/Pakistani, and 7.7% others) 81.9% of the patients selected epidural. Between those that selected and declined epidural there were no differences in education and insurance.There were no statistically significant differences in epidural utilization among the ethnic groups(p=0.07). Chinese/Korean patients had the shortest duration of analgesia and African/American and Hispanic patients had the longest (141 min104.7, 185.4min128.3, 174.3121.2 respectively).Hispanic patients had the highest use of bupivacaine (7.3 mg/hr) and Chinese/Korean patients had the least (5.5 mg/hr) (p<0.0001). Baseline pain scores for those requesting epidural were higher (8.81.3 than those declining epidural (3.71.5) (p<0.0001), but there were no differences between ethnic groups.Pain relief was equally efficacious between ethnic groups after epidural placement. There was a similar high level of patient satisfaction among all ethnic groups. Parity and ethnicity predicted epidural use by logistic regression. Nulliparas chose epidural more than multiparas (OR=4.0, 95% CI 2.6-6.2, p<0.0001). Hispanics chose epidural more than Chinese/Koreans (OR=2.07, 95% CI, CI 1.1-4.0,p=0.03).

Conclusion: When equal access to epidural analgesia is available, all ethnic groups choose epidural analgesia in similar proportions. Socioeconomic factors and level of education were not associated with differences in the use of epidural. Our prompt education about and performance of labor analgesia is in keeping with the Healthy People 2010 goals in eliminating racial disparities in pain management.

1.GlanceLG,et al. Anesthesiology 2007;106:19-25

SOAP 2009