A PROSPECTIVE AUDIT OF QUALITY OF LABOR ANALGESIA AND MATERNAL SATISFACTION AT A TERTIARY TEACHING CENTER.
Abstract Number: F-1
Abstract Type: Original Research
Introduction: The current practice of neuraxial labor analgesia is thought to be evidence based. This evidence comes from studies conducted in controlled settings, and do not account for the variability of the daily practice. Prospective audits of quality and safety of labor analgesia, including maternal satisfaction, are uncommon in the literature(1). The purpose of this audit was to prospectively evaluate the effectiveness and safety of labor analgesia provided at a tertiary teaching center, as well as maternal satisfaction.
Methods: This was a prospective audit approved by REB and with patient consent. All women requesting neuraxial labor analgesia in November 2011 were approached. Patients were managed as per routine with a test dose and a loading dose of local anesthetic, followed by a PCEA with bupivacaine 0.0625%+fentanyl 2mcg/ml, and PRN top-ups. The PCEA solution could be changed to bupivacaine 0.125%+fentanyl 2mcg/ml. After delivery, patients were given a satisfaction questionnaire. Furthermore, MD’s and nursing’s notes were reviewed to ensure that all data pertaining to the audit had been captured.
Results: There were 508 deliveries in the study period, 332 patients were eligible, 10 (3%) refused to participate and 28 (8.4%) were lost follow-up. Most patients (274) received epidural analgesia. The mean dilatation and pain score (NRS 0-10) at the time of request of analgesia was 4.8±2.0cm and 7.6±2.2, respectively. There was no intravascular catheter placement, there were 3 (1.03%) unintentional dural punctures and 13 (4.4%) catheters had to be replaced. The incidence of SVD and CS were 71% and 15.9% respectively. About 40% of the patients reported pain score >3 at least once after the activation of the epidural. The number of patients who received top-ups by nurses and MDs was 106 (36%) and 72 (24%) respectively. The maintenance solution was switched in 23 (7.8%) women. Satisfaction questionnaire responses are shown in Table 1.
Discussion: Overall, the incidence of complications was small and similar to previous reports(1). Although the 0.0625% bupivacaine solution has been shown to be efficacious for labor analgesia(2), in our daily practice the incidence of moderate to severe pain was high, which motivated a large number of top-ups. Interestingly, very few women had the maintenance concentration increased. Despite this, more than 80% considered that their epidural worked well.
References: 1.IJOA. 2004;13:227-33; 2.IJOA. 2005; 14:223-9.