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Do epidural catheters placed with CSE technique delay the recognition and replacement of failed epidural catheters as compared to those placed with traditional technique for labor analgesia.
Abstract Number: S 28
Abstract Type: Original Research
Background: Combined spinal epidural (CSE) is popular for labor analgesia. Cochrane review demonstrated the benefits of CSE having faster analgesic onset and lower requirement for rescue analgesia. However, some institutions recommend not using CSE labor analgesia in morbid obese patients or those at risk for cesarean delivery (CD) with concerns that recognition of epidural catheter (EPID) failure requiring replacement would be delayed with CSE versus EPID technique. The aim and the hypothesis of this study is to show the timing of epidural catheter replacement among failed epidural catheters placed with CSE is not delayed as compared with EPID technique.
Methods: After IRB approval and exemption of consent, a 6-month prospective data collection of CSE or EPID placement of labor analgesia is being performed utilizing anesthetic and quality assurance records to determine characteristics, timing, rates and predictive factors of failed epidural catheters. Epidural catheter failures needing replacement were divided into 2 categories – Inadequate or no block, and IV/CSF in catheter or technical failure (e.g unable to inject). Chi-squares, Fisher exacts test, unpaired t-test and logistic regression are applied as appropriate. P<0.05 is considered significant.
Results: Preliminarily, 3 of the planned 6 months of data collection were completed with 388 and 617 epidural catheters placed via EPID and CSE technique, respectively. Epidural catheter required replacement during the course of labor in 11.8% of EPID and 6.8% of CSE group (P<.008). In addition, 9 of the 74 failed catheters in EPID group and 3 of 45 in CSE group failed when needed for CD(P<.04). Inadequate/No block failure comprised 78.2% of EPID failure, with replacement incurring 453± 402 min vs. 59.5% of CSE, with replacement at 249± 213 min after initial catheter placement (P<.02). Of all Inadequate/No block failure, 8% of EPID and 12% of CSE catheters were replaced within 1 hour of initial placement. Of all IV/CSF/Tech failure, 21.7% of EPID were replaced 8± 3min vs. 40.5% of CSE replaced at 18± 25min. The number of rescue top ups needed were higher in EPID vs. CSE placed catheters (P<.0004). Demographics and provider training level were similar between groups except for higher patient weight (182 vs. 196 lbs) in EPID group. When dichotomizing those above or below 250 lbs, the time to replacement and other failure characteristics were not different between those above or below 250lbs. Furthermore, logistic regression showed neuraxial technique (CSE vs. EPID) and/or number of top ups required, but not weight, uniquely predicted catheter replacement (P<0.03 and P<0.001, respectively).
Discussion: Our preliminary data suggests recognition and replacement of epidural catheter failures is not delayed with CSE vs. EPID technique. Future prospective randomized study would further validate the findings of this study.