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Postpartum Tubal Ligation (PPTL) and Type of Anesthesia: How successful are our neuraxial interventions?
Abstract Number: SAT-32
Abstract Type: Original Research
Tubal ligation in the immediate postpartum period is typically performed on the Labor and Delivery Suite. Use of an existing epidural catheter has been advanced as an efficient way to provide anesthesia for PPTL(1). Reported epidural reactivation success rates vary from 74% to 92%. Predictors for failure include poor patient satisfaction with labor analgesia, increased delivery-to-reactivation time, and the need for top-ups during labor and delivery(2). Within our practice and the obstetric anesthesia community, some providers have suggested that labor analgesic epidurals activated for PPTL have a failure rate that does not justify leaving a catheter in place after delivery for subsequent attempts at reactivation. We undertook this study to evaluate this claim and determine if there are predictors that can refine our anesthetic decision making.
After obtaining IRB approval, a retrospective chart review from July 2010 to July 2016 was conducted using CPT codes. Demographic data, obstetric data and anesthetic data (labor analgesia administration, length of epidural catheter in epidural space, top-up requirements, time of catheter reactivation, final anesthetic technique and corresponding doses for spinal and epidural anesthesia) were obtained.
Data from 93 patients were analyzed. Distribution of anesthetic technique used for the PPTL is presented in figure 1. 70 patients had labor neuraxial analgesia, and the reactivation success of epidural catheters was 66.7%. No demographic or anesthetic factors were predictive of failure to reactivate. The success rate for spinal anesthesia, both de novo and after unsuccessful epidural reactivation, was 80%. Intrathecal fentanyl doses above 20 mcg added to bupivacaine were associated with spinal failure (p=0.001).
Our successful postpartum epidural reactivation rate for tubal ligation is lower than the range reported in the literature. We found no association between previously reported risk factors and unsuccessful epidural reactivation. The success rates for both spinal anesthesia and epidural reactivation for PPTL is lower than the reported 95% for cesarean delivery(3). This may reflect a lower level of motivation on behalf of both the patients and anesthesia providers to tolerate suboptimal anesthesia when fetal considerations are removed.
1. Goodman EJ, 1998
2. Powell MF, 2016
3. Bauer ME, 2012