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The Influence of an International Teaching Program on the Use of Regional Anesthesia for Cesarean Section in a Serbian Obstetric Hospital Over a Two Year Period
Abstract Number: S-61
Abstract Type: Other
Introduction: Regional anesthesia (RA) is infrequently used for cesarean section (CS) in Serbia, Factors may include poor parturient knowledge about RA benefits, perceived safety of general anesthesia and poor availability of anesthesiologists skilled in RA1. In 2003-2004, the Department of Anesthesia at Clinical Center Vojvodina (CCV) began a patient education program regarding RA use for CS. The use of RA rose from 6% in 2004 to 24% in 2009; however, in 2011, only 260 of 1860 CS (14%) had RA. Kybele is a dedicated to improving childbirth safety worldwide through educational programs. A four man team sponsored by Kybele visited CCV in 2012 and the percentage of CS with RA rose to 29.5% during the 2 months afterward. Neuroaxial analgesia (NA) for labor was emphasized. This study updates the ongoing joint efforts of Kybele and CCV physicians to increase RA use in CCV following a return visit in 2013.
Method: A team of two OB anesthesiologist, re-visited CCV in September 2013 to provide training in RA and NA. We prospectively compared the use of RA for CS one week before the visit (R1), the week during (R2), and at one (R3) and two (R4) weeks and two months (R5) following the visit. The use of NA for labor was also recorded. We compared the results to those from 2011/2012. Chi square testing was used for comparisons between groups.
Results: For both yearly visits significant increases in the use of RA for CS occurred during the Kybele visit and during some time intervals following visits in 2012/2013 (Table 1). Year over year increases were modest, but statistically significant. NA increased from 161 out of 4312 vaginal deliveries in 2012 to 253 out of 4330 vaginal deliveries in calendar year 2013 (57% increase).
Conclusion: The collaborative program between CCV and Kybele increased the use of RA for CS during the period of visitation and for some time intervals shortly afterward. Long term increases in use of RA for CS and NA are modest compared to the 84% increase reported by Kopic1. This probably reflects the additional cost that is associated with RA procedures, limited availability of anesthesiologist, and lack of PE on the benefits of RA and NA. The local team has prepared a brochure about RA for CS and NA for labor to supplement patient education. A future Kybele team visit will see if additional training of local anesthesiologist, and use of patient education efforts will increase RA and NA utilization.
Reference:1.Kopic IJOA 2009;18:4.