THE DURATION AND DEGREE OF DIFFICULTY IN LABOR EPIDURAL PLACEMENT: DO PATIENT, NURSE AND ANESTHESIOLOGIST PERCEPTIONS MATTER?
Abstract Number: F-7
Abstract Type: Original Research
Introduction: The duration and difficulty of epidural placement has been attributed to number of attempts, obesity and scoliosis (1,2). However, patient and provider perceptions regarding the duration and difficulty of the epidural technique and time to comfort remain undefined and may impact patient satisfaction, provider-patient interactions, and staff communications. The aim of this study was to determine if perceived expectations for duration and difficulty of epidural placement differ between patients, labor nurses, and anesthesiologists and how these perceptions related to the actual elapsed time and difficulty.
Methods: In this observational study, the patient, nurse and anesthesiologist completed a questionnaire before and after epidural placement. Participants predicted the duration and difficulty of the placement, time from catheter insertion to achieving comfort (VAS <3/10) and factors affecting their responses. The actual times and details of placement, analgesia and patient demographics were recorded. A standardized epidural dose (1.5% lidocaine + epi 3mL with 0.125% bupivacaine +fentanyl 2 mcg/mL15 mL) was used.
Results: Twenty-six of 60 parturients requesting labor analgesia were recruited to date. All groups overestimated the degree of difficulty and the predicted and perceived times associated with the epidural technique. Patients’ perceptions of time to analgesia were shorter than actual time. The most important influences on estimating duration and difficulty of placement were personal experience and elapsed time, respectively. Increasing anesthesia training level correlated with both more accurate perception of time for placement and nurses’ estimation of placement ease. Results are summarized in Table 1.
Discussion: Our study observed that perceived difficulty by the patient and providers with the epidural technique is related to total elapsed time and not the number of attempts. Scoliosis, ability to curve the back and BMI > 40kg/m2 were related to difficult placement. Reconciling how patients and providers perceive duration and difficulty of epidural placement and the time to analgesia may improve patient communication and satisfaction, and provider expectations for when an epidural will be difficult and when analgesia should be established. Realistic expectations for duration of placement and time to analgesia may also impact provider work-force management.
1. Int J Obstet Anesth 2011;20(2):124-127
2. Anesth Analg 2009;109(4):