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The Influence of an International Teaching Program on the Use of Neuraxial Analgesia for Labor and Regional Anesthesia for Cesarean Delivery in a Serbian Obstetric Hospital
Abstract Number: SA-40
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). 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 visits to CCV to provide didactic and hands-on training. In 2015, a Kybele team, visited CCV twice to conduct training in RA and neuraxial analgesia for labor (NAL). 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. Multiple logistic regression was used to quantify the changes in odds of RA across weeks adjacent to visitation and visit sequence. Simple logistic regression was used to assess the annual changes in the odds of RA and NAL use.
Results: Adjusting for the visit sequence (1 visit in 2012-14 and 2 visits in 2015), the odds of RA during the week of visitation are 2.5 times greater (OR: 2.57; 95% CI: 1.60, 4.14) than the preceding week. However, RA use regresses: the week after, the odds of RA were 1.96 (95% CI: 1.22, 3.16) than the pre-visit odds. By week 2 and 8, the ORs were 1.66 (95% CI: 1.01, 2.72) and 1.70 (95% CI: 1.04, 2.79). While the trend across visits indicates increasing RA use over time, only at the June, 2015 visit were the odds of RA use greater relative to the 2012 visit (OR: 1.78; 95% CI: 1.11, 2.85). NAL increased 57% from 2012 to 2013, 42% from 2013 – 2014, and 31% from 2014 – 2015 (330% increase overall, p< 0.001 for the trend)
Conclusion: With the help of the Kybele team, the use of RA for CS increased 87% over the 4 year period. Use of NAL increased nearly 3 ½ times. The limited availability of trained anesthesiologists and a lack of patient education on the benefits of RA and NAL are likely barriers to further increased RA and NAL use. Future Kybele team visits for training of practitioners beyond CCV and to improve patient education to increase RA and NAL utilization are planned.