///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Does a Previous Neuraxial Procedure affect Subsequent Epidural Success Rate in Obstetric Patients?

Abstract Number: 266
Abstract Type: Original Research

Shruti Shah M.D.1 ; Shaul Cohen M.D.2; Deeksha Chopra M.D.3; Christine W. Hunter M.D.4; Sachin Katyal M.D.5; Renu Chhokra M.D.6

INTRODUCTION:A repeated epidural block involves a higher failure rate (18%) following a previous epidural block(1)or a previous wet tap(2) However, no epidural opioid was added.We conducted prospective study in order to assess the incidence of technical problems and the efficiency of epidural block in parturients with or without a previous history of (H/O)neuraxial procedure who received epidural ropivacaine(R) analgesia with fentanyl(F)& epinephrine(E) adjuvants.

METHODS:Following IRB approval and informed consent,2735 parturients who requested epidural analgesia for labor pain were included. Gp I (n=1628): had no H/O neuraxial procedure, Gp II (n=1107): had H/O neuraxial procedure. The epidural space was identified by using the standard loss of resistance technique with an air. A 19-gauge B. Braun catheter was inserted 5 cm into the epidural space via a midline 17-gauge Hustead needle. After a test dose of 3ml 1.5% lidocaine + 5g/ml epinephrine, patients received R 0.1% + F 4g/ml + E 2g/ml as a 10ml loading dose followed by an infusion at 6ml/hr. Pts could administer a PCA dose of 4ml with lockout time of 10min (PCA pump).After administration of the loading dose (time = 0min), pts were queried with each contraction as to their satisfaction with analgesia. If at time = 20min, VAS>3, pts were given a 5ml bolus of the epidural solution every 10min for a maximum of 3 doses as needed until VAS<3.If analgesia was still inadequate (VAS>3), pts were rescued with 5ml of 0.25% R every 10min as needed to a maximum of 20ml.Maximum of 12ml/hr infusion rate. H/O previous neuraxial procedure, technical problems and efficiency of the block, difficulty with catheter insertion, blood or CSF in catheter, catheter induced paresthesia &/or involuntary leg movement were recorded. The catheters were used for C/S anesthesia & were kept for up to 96 hrs for post C/S analgesia.

RESULTS: There were no differences among the groups with respect to infusion duration,maximal sensory level,difficulty with catheter insertion, kinking, intravascular,intrathecal migration, readjustment,reinsertion, dislodgment, difficulty with removal,c/o catheter paresthesia(35%&41% for Gp I&II respectively)and overall satisfaction(9.5 for GI&II).

Table:1

Conclusion: A previous H/o neuraxial procedure increased the incidence of one sided anesthesia, visible paresthesia & reduced the catheter insertion satisfaction rate without affecting overall satisfaction.



SOAP 2009