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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
Abstract Number: S-27
Abstract Type: Original Research
Introduction: In Serbia, the use of regional anesthesia (RA) and analgesia techniques for obstetrics has been low, despite local efforts to increase the use. Members of the Department of Anesthesia at Clinical Center Vojvodina (CCV), requested a multi-year Kybele program in 2012 to help train physicians in the use of RA techniques for labor and cesarean section (CS). CCV is the largest obstetric hospital outside the capital Belgrade with approximately 6500 deliveries per year. Initially, training was provided to CCV faculty, but now education extends to resident physicians and to faculty from surrounding hospitals. In order for CCV to become recognized as a leading facility in obstetric anesthesia, the use of RA techniques must gradually increase. This study updates the efforts of Kybele and CCV physicians to increase obstetric RA use.
Method: Since 2012, Kybele has conducted annual 7-10 day visits to CCV to provide didactic and hands-on training. In September 2014, a Kybele team of 3 obstetric anesthesiologists, visited CCV for 7 days to conduct training in RA and neuraxial analgesia for labor (NAL). As in previous years, data was prospectively collected on 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. NAL use was also recorded. The use of RA for CS was compared between years using Chi square with Bonferroni correction.
Results: The interval and annual use of RA for CS in conjunction with the Kybele visits made in 2012-2014 is shown in the table 1. The annual increases in RA for CS are statistically significant. NAL increased from 161/4312 vaginal deliveries (VD) in 2012 to 253/4330 VD in 2013 (57% increase over 2012) to 360/4500 VD in year 2014 (42% increase over 2013).
Conclusion: The collaboration between CCV and Kybele increased the use of RA for CS during the period of visitation compared to the previous year’s percentage and for some time intervals afterward. Long term increases in use of RA for CS and are less than the 84% increase reported by Kopic1 but have consistently increased one year to the next. Significant increase in the use of NAL was also noted. There remains limited availability of trained anesthesiologists and a lack of patient education on the benefits of RA and NAL. Future Kybele team visits for training of practitioners beyond CCV to increase RA and NAL utilization are planned.
Reference:1. Kopic IJOA 2009;18:4.