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REGIONAL ANESTHESIA FOR CAESAREAN SECTION IN A SERBIAN OBSTETRIC HOSPITAL BEFORE AND AFTER A COLLABORATIVE TEACHING PROGRAM
Abstract Number: S 12
Abstract Type: Original Research
Introduction: Regional anesthesia is infrequently used for cesarean section (CS) in Serbia, irrespective of whether surgery occurs in university or non-university hospital settings. Factors for this may include poor parturient knowledge about regional anesthesia (RA), widespread belief that general anesthesia (GA) is always safe and poor availability of anesthesia personnel skilled in RA. Several years ago, the Departments of Anesthesia and Obstetrics and Gynecology at Clinical Center Vojvodina began an educational program for parturients regarding RA use for CS. The use of RA rose from 6% in 2006 to 24% in 2009; however, in 2011, only 14% of CS were performed with RA (260 of 1860 total).
Method: A four member team (two OB anesthesiologists, an obstetrician and a neonatologist) sponsored by Kybele visited our university hospital in September 2012 to provide education and training in RA and other aspects of perinatal care. We prospectively compared the use of RA for CS one week before the visit (R1), the week during (R2), one week (R3), two weeks (R4) and two months following the visit (R5). Chi square was used for comparisons between baseline (2011) and the respective groups.
Results: For R1, RA was used for 15.9% of patients (SA 11.4% and epidural anesthesia 4.6%) (P = 0.5). Neuraxial analgesia for labor (NA) was used in 10 patients. During (R2) 32.5% of CS were done under RA (P < 0.01) and NA was used in 21 parturient. During (R3) 22.2% of CS were done under RA (P = 0.03) and NA was used in only 3 parturient. During (R4) RA was used in 24.4% of CS (P = 0.01) and labor analgesia was used in only 2 parturients. Two months after the Kybele visit (R5) 29.2% of CS were done under RA (P < 0.01) and NA used in only 2 parturients
Conclusion: The collaborative program in obstetric anesthesia between Clinical Center Vojvodina and Kybele increased the use of RA for C/S, similar to the results reported by others1. Although not measured, we believe this was due to enhanced staff awareness of RA and better patient education in both RA and GA after the Kybele trip. The small number of NA cases is probably the result of additional cost that is associated with the procedure and limited availability of anesthesiologists. We have prepared a brochure about RA for CS and NA for labor to supplement our current patient teaching program. We plan a future Kybele team visit to see if this increases our RA and NA utilization.
1.Kopic D et al. The impact of a teaching program on obstetric anesthesia practices in Croatia. IJOA 2009; 18:4-9.