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A Survey of American Anesthesiologists Regarding Current Practices in Neuraxial Labor Analgesia
Abstract Number: 47
Abstract Type: Original Research
Background: To identify controversial issues for further investigation regarding neuraxial labor analgesia, we surveyed a cross-section of American anesthesiologists regarding their practices in neuraxial labor analgesia.
Methods: The survey received exempt status from the Institutional Review Board. 192 anesthesiologists with an interest in Obstetric anesthesia were contacted by electronic mail and asked to complete a 25-question, anonymous, online survey.
Results: 91 responses were received (47.4%). Consensus was strong in several areas; 90.9% of respondents denied requiring an arbitrary cervical dilation prior to neuraxial labor analgesia, 97.8% approach the epidural space from the midline, 83.5% place the epidural catheter either 4 or 5 cm within the epidural space, 93.4% agree on using dilute local anesthetic for maintenance (0.125% bupivicaine or less), 97.8% routinely use opioid in epidural maintenance solution, and 74% address inadequate epidural analgesia for labor administering a supplemental dose of local anesthetic after withdrawing the epidural catheter 1 cm. Other areas demonstrated a wide array of opinions (Table 1).
Concluding the survey were questions regarding six techniques (paramedian approach, increased depth of epidural insertion, fluid expansion of the epidural space prior to catheter insertion, increased bolus solution volume, loss of resistance to air, and combined spinal/epidural) and their perceived effect on the frequency of unilateral epidural blockade, epidural failure, intravascular catheter placement, and inadvertent subarachnoid placement. For unilateral epidural blockade, only increased insertion depth (86.7% felt it increased frequency) and increased volume of bolus solution (70.0%, decreased frequency) were felt to have any effect by more than half of respondents. For intravascular epidural placement, only increased insertion depth (68.9% increased) and epidural space volume expansion (64.4% decreased) were felt by more than half to have any effect. None of the techniques were felt by more than 50% to have any effect (positive or negative) on failed epidural blockade or inadvertent subarachnoid catheter placement.
Conclusion: While some consensus exists in the provision of neuraxial labor analgesia, there are many areas which remain controversial. Specifically, factors effecting unilateral or failed epidural and intravascular or intrathecal catheter placement appear to remain without wide consensus.