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Is the dose of oxytocin pre-delivery associated with more epidural drug consumption?
Abstract Number: F 27
Abstract Type: Original Research
Background: The administration of oxytocin for induction or augmentation of labor is widely used, and has been increasing. Women who undergo induction of labor tend to have greater epidural utilization perhaps because oxytocin administration results in a more painful labor. (1, 2) We examined whether higher oxytocin administration as calculated from an Area Under the Curve (AUC) required greater epidural drug administration as measured by AUC.
Methods: After IRB approval, a manual retrospective medical chart review was performed for calendar year 2008. Inclusion criteria was primigravid women aged >18 years admitted with a gestational age >36 weeks in spontaneous labor and received oxytocin for labor augmentation. The dosage rate and time interval of oxytocin administration prior to delivery was used to calculate a total pre-delivery oxytocin area under the curve (AUC). Epidural medications were also calculated as AUC as both infusion and bolus dosing. At our institution epidural analgesia is provided by a 0.2% ropivacaine infusion without narcotic and anesthesiologist administered boluses of either ropivacaine, bupivacaine, lidocaine, or chloroprocaine with or without fentanyl. Epidural boluses were converted to ropivacaine equivalent dose in mg by minimal local anesthetic concentration equivalency. (3) Epidural AUC was divided by the epidural duration, to obtain an hourly ropivacaine equivalency rate, in order to account for differences in duration of epidural use. Oxytocin AUC were divided into quartiles of oxytocin exposure, and were compared to the average hourly ropivacaine equivalent rate. ANOVA analysis was performed, p<0.05 was statistically significant.
Results: Based on the inclusion criteria there were 216 patients were divided into oxytocin quartiles. The augmented group showed increasing total (infusion and bolus) and bolus ropivacaine requirements with increasing quartile of oxytocin AUC, P< 0.0001. The increasing ropivacaine requirement still held even when comparing mean hourly ropivacaine requirements against quartile oxytocin AUC by ANOVA p=0.035.
Conclusion: Higher oxytocin dosing results in increased pain as measured by higher epidural drug requirements. Higher oxytocin AUC resulted in patients requiring more total epidural medication, even after adjusting for infusion duration, indicating more painful labor. Labor augmentation will increase utilization of anesthesia services as measured by number of required physician boluses despite the use of PCEA. The need for more epidural bolus administration with higher oxytocin exposure may be perceived as a failed epidural by patients and negatively impact patient satisfaction.
1. Midwifery. 2012 Oct 15. pii: S0266-6138(12)00158-1.
2. Aust N Z J Obstet Gynaecol 2011; 51:151-7.
3. Br J Anaesth 1999;82:371-3.