///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

When is the performance of a labor epidural technique considered "difficult"? Differences among anesthesiologists, nurses, and patients

Abstract Number: T 17
Abstract Type: Original Research

Allison Clark MD1 ; Guilherme Holck MD2; Bryan P. Mahoney MD3; Michaela K. Farber MD4; Lawrence C. Tsen MD5

Introduction: The performance of a labor epidural technique is not infrequently noted as being “difficult”, although the interpretation of this term is quite variable. We sought to determine whether procedure duration and difficulty could be predicted in advance, what factors were responsible, and whether anesthesiologists, nurses, and patients had similar impressions.

Methods: A total of 140 sets (i.e., an anesthesiologist, nurse and patient) of individuals were asked to complete a questionnaire immediately prior to, and upon completion of, a standardized labor epidural technique. Procedure duration was defined as time from insertion of the needle for local anesthetic deposition to removal of the epidural needle from the skin insertion site; this was timed in seconds by an independent co-investigator. Procedure duration was estimated before and after the epidural technique. Procedure difficulty was also estimated before, and ranked after, the epidural technique with contributing factors indicated. Demographic data for all groups was recorded.

Results: Estimated and actual procedure duration comparisons by group were recorded (Figure 1). For all groups, post-placement ratings of procedure difficulty correlated with actual procedure duration (p<0.0001). Mean actual procedure durations for post-placement “difficult” ratings were 8.37, 9.57, and 8.05 minutes for anesthesiologists, nurses, and patients, respectively. Mean actual procedure durations for post-placement “very difficult” ratings were 18.80 and 20.96 minutes for nurses and patients, respectively; anesthesiologists did not use this rating. The leading reasons cited for a “difficult” or “very difficult” ratings by anesthesiologists, nurses, and patients were the actual procedure duration, the number of attempts, and the amount of pain experienced, respectively.

Conclusion: The duration and difficulty associated with the insertion of a labor epidural technique can be estimated. A “difficult” labor epidural technique is associated with procedure duration, but the reasons for this rating differ by group queried. These findings are helpful when discussing expectations for the procedure and defining the meaning of a “difficult” labor epidural technique.


1. Bucklin, et al. Anesthesiology 2005;103:645-653.

5. Faitot, et al. Int J Obstet Anesth 2011;20:124-127.

SOAP 2013