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Catheter Failure Rates and Time Course with Epidural versus CSE Analgesia in Labor
Abstract Number: F-42
Abstract Type: Original Research
Introduction: The combined spinal-epidural (CSE) technique for labor analgesia has several advantages over the traditional epidural (EPI) technique, including faster onset, greater maternal satisfaction, and decreased need for physician boluses1. However, proponents of EPI criticize the CSE technique using the argument of the “untested catheter.”1 We have compared the failure rates and time of failure between techniques in our tertiary care academic practice.
Methods: Data regarding failed catheters (FC) was collected prospectively from Oct. 2012-Sept. 2014 as part of our QA program. FC were defined as any catheter that was replaced after initially thought to be properly placed, and then determined to be: intravascular, one sided or resulting in poor maternal analgesia. Data collected included age, height, weight, BMI, gravity, parity, depth to epidural space, catheter mark at skin, number of physician boluses, and time between catheter placement and identification of the FC. Rates of failure between techniques were compared, Kaplan-Meier survival curves created and Cox proportional hazards analysis performed to determine if a difference exists between the times to recognize FC with CSE vs EPI.
Results: A total of 5487 analgesics were performed (1507 EPI; 3980 CSE). There were no differences between the groups in any demographic variable. 85 CSE (2.1%) and 59 EPI catheters (3.9%) were replaced during labor (P< 0.001). Data regarding time to replacement was available for 80 CSE and 57 EPI. Mean time to replacement was 434 min and 606 min for the EPI and CSE groups respectively (p=0.02). Median time to replacement was 281min (IQR 186,767) and 398 min (IQR 131, 578) for EPI and CSE groups, respectively. The time course for detection of failure differed between groups (Fig 1, p=0.014).
Conclusion: We were able to demonstrate that catheters placed using a CSE technique were less likely to fail during labor and that the time to detection of a FC was significantly longer in the CSE group. The time for the recognition of a failed catheter was much more than the 1-2 hour period during which the catheter from a CSE could correctly be viewed as “untested.” These results are consistent with those of Gambling et al1 and Norris et al2. Our findings validate CSE as a reliable technique for labor analgesia and tend to refute the theory of the “untested catheter.”
1. Anesth Analg 2013;116:636–43.
2. Int J Obstet Anesth 2000;9:3–6.