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

Relation between Combined Spinal Epidural Characteristics and Spinal/Epidural Labor Analgesia Outcomes - A Daily Problem/Decision Encountered by OB Anesthesiologists that has not been Answered Previously !!

Abstract Number: 44
Abstract Type: Original Research

Brian Paitsel MD1 ; Kenneth Nelson MD2; Lynne Harris BSN3; Peter H Pan MSEE, MD4; Lydia S Grondin MD5

BACKGROUND:Though combined spinal epidural labor analgesia (CSE) has become widely utilized, the relation between CSE characteristics (i.e. presence/absence of spontaneous fluid return to spinal needle, yield of fluid from aspiration before and after spinal drug injection) and outcomes of spinal/epidural analgesia success hasnt been studied, and is the goal of this study.

METHOD:After IRB approval & informed consent, and as part of a larger study to evaluate neuraxial efficacy, 360 parturients requesting neuraxial analgesia were enrolled for CSE placement using loss of resistance to either air or saline technique. Presence/Absence of spontaneous fluid return to spinal needle & fluid yield on aspiration pre and post spinal drug injection were documented. Spinal drug(0.6mL bupivacaine 2.5mg/mL+0.4mL fentanyl 50mcg/mL) was injected if spontaneous fluid return was observed (regardless of ability to aspirate fluid. Then epidural catheter was inserted 6cm & EPCA initiated. Primary outcomes were spinal analgesia success (defined as VAPS <=3 at 15m postspinal drug injection) & epidural efficacy (defined by hourly epidural drug consumption & catheter replacement). Chi-square & Fishers exact test(incidence and proportion) and 2-tailed unpaired test(drug consumption), Mann-Whitney U-test(non-parametric) & ANOVA(continuous measure) were applied with P<0.05 as significant.

RESULTS: 360 enrolled & 15 were excluded. Overall spinal analgesia success rate was 93.9%, among which 7 patients (2%) didnt have spontaneous fluid return. Excluding those without spontaneous fluid return, overall spinal analgesia success was 95.9%. Among those with initial spontaneous fluid return, 36 (10.7%) and 42 (7.5%) were unable to aspirate fluid prior to or after spinal drug injection, respectively. However, the spinal analgesia success (94.4% & 97.6% for negative pre/post injection aspiration, respectively) werent different from those with positive pre/post injection aspiration. Hourly epidural drug consumption was similar among groups with positive or negative pre or post injection aspiration after having initial spontaneous fluid. However, epidural catheter replacement was significantly higher among those inserted after without being able to observe spontaneous fluid at spinal needle insertion, among which 28.6% required catheters replaced vs only 4.1% from all studied patients (P<0.03)

DISCUSSION:Whether spinal or epidural anaglesia works in CSE if no initial spontaneous fluid is observed or if pre or post spinal drug aspiration is negative is a daily encounter by OB anesthesiologists that has not been answered previously. Our study shows that epidural catheters inserted in CSE with absence of initial spontaneous fluid return to spinal needle pose a high epidural failure risk. However, the practice of aspiration after observing initial fluid return may be unnecessary as the practice does not alter spinal/epidural analgesia outcomes.

SOAP 2009