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

Anesthetic management of Post partum tubal ligation (PPTL) in patients with an existing epidural catheter: A retrospective study.

Abstract Number: 79
Abstract Type: Original Research

Gokul Toshniwal M.B B.S, MD1 ; Anthony Spearman BMS2; Hassan Hammoud BMS3; George McKelvey PhD4; H Michael Marsh M.B. B.S5; Vitaly Soskin MD. PhD6

Introduction:

Postpartum tubal ligation is a common procedure performed on a voluntary basis. The most commonly used anesthesia for post partum tubal ligation (PPTL) is regional anesthesia, which can be either the reactivation (a bolus of local anesthetic) of the epidural catheter, placed for the purpose of labor analgesia or a subarachnoid block (SAB). Some patients may require general anesthesia (GA) for the procedure if regional anesthesia fails or contraindicated. Controversy still exists regarding the factors that affect the success rate of the epidural catheter, reactivated for PPTL. In lieu of this controversy, the aim of this study was to review all cases with reactivation of epidural catheter for post partum tubal ligation over last 2 year at our institution.

Methods and Material:

After IRB approval, charts of all patients who underwent PPTL and had an epidural catheter placed for labor analgesia in last 2 years were reviewed. Total of 254 charts were reviewed and only 185 fully completed charts were analyzed for factors influencing the efficacy of epidural for PPTL.

Results:

Epidural catheter was reactivated in 232 out of 254 (91.3%) patients undergoing PPTL. It was successfully used in only 151 out of 232 (65%) patients and 53 out of 232 (23%) patients required significant amount of anesthetic agent during the procedure. 28 out of 232 (12%) patients required alternate anesthetic technique (SAB or GA) because surgical level with epidural anesthesia couldnt be achieved. Among these patients, SAB was performed in 22 out of 28 patients (78.6%) without any complications and 6 out of 28 (21.4%) patients required GA. Only 185 fully completed charts were analyzed for factors (i.e.) the length of catheter in epidural space, duration of epidural analgesia for labor, duration for which catheter was inactive or duration between delivery and PPTL and number of boluses patient received during labor that may influence the failure of the epidural anesthesia for PPTL. None of these factors were found to have statistically significant relationship with failure of epidural anesthesia for PPTL.

Conclusion:

Postpartum period is equally critical with regard to airway management as in pregnancy. Hence, risking the patient for GA is not advisable. Epidural anesthesia may look feasible technique for PPTL in patients with epidural catheter for labor analgesia. This study and previous literature show that the success rate of this technique is relatively low. Also the risk of infection increases with time, the catheter is in epidural space. So we propose to consider SAB as the technique of choice for PPTL even though the patient had an epidural catheter during labor.

SOAP 2009