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Number of Clinician Boluses Administered During Labor Predicts Failure to Activate Labor Epidural for Postpartum Tubal Ligation: A Retrospective Review
Abstract Number: F2A-5
Abstract Type: Original Research
STUDY OBJECTIVES: Determine risk factors that increase the failure rate of labor epidurals reactivated for surgical anesthesia for postpartum tubal ligation (PPTL) and estimate the failure rate of reactivated epidurals for postpartum tubal ligations.
METHODS: Subjects undergoing postpartum tubal ligation with a labor epidural used as the primary anesthetic from February 1, 2014-September 30, 2017 at our hospital were included. The number of boluses given during labor, time from delivery to PPTL, loss of resistance depth, administration of intravenous (IV) opioids and/or nitrous oxide during the procedure, age, gravity, parity, height, weight, body mass index (BMI), and gestational age were retrieved from the electronic medical record
RESULTS: 87 subjects met inclusion criteria for the study. 70 subjects (80%) had successful activation of labor epidurals with four of these subjects receiving supplemental nitrous oxide. 15 subjects required conversion to general anesthesia, one subject required deep sedation, and one subject had her procedure cancelled due to inadequate analgesia. A significant risk factor for failure of activation was the number of clinician boluses administered during labor (P= .0031). 65, 13, and 9 subjects had zero, 1, and two or more clinician boluses administered during labor, respectively; the success rate for catheter activation for PPTL in these groups was 88%, 77%, and 56%, respectively. Administration of IV opioids (P< .0001) and nitrous oxide (P=.0437) during PPTL were also associated with catheter activation failure. Too many subjects had missing height, weight, and BMI data for these factors to be included in the statistical analysis.
CONCLUSION: Our success rate for activation of labor epidurals for PPTL was consistent with rates previously cited in the literature (1-2). In our hospital practice, we tend to avoid reactivating labor epidurals more than four hours after delivery; this may explain why time from delivery to PPTL did not predict successful catheter activation. In our study, the number of clinician epidural boluses administered during labor was significantly higher in the failure group; our results further suggest that a labor epidural requiring more than one clinician bolus (and possibly any clinician bolus) may not be suitable to use for PPTL. A limitation of our study was that missing data for height and weight prevented statistical analysis of those variables.
1. Mark F. Powell, Douglas D. Wellons, Steve F. Tran, John M. Zimmerman, Michael A. Frölich, Risk factors for failed reactivation of a labor epidural for postpartum tubal ligation: a prospective, observational study. J Clin Anesth, 35 (2016) pp. 221-224
2. EJ Goodman, SD DumasThe rate of successful reactivation of labor epidural catheters for postpartum tubal ligation surgery. Reg Anesth Pain Med, 23 (1998), pp. 258-261