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Replacement for Failed Epidural Catheter in Parturient: A Retrospective Chart Review
Abstract Number: F4D-5
Abstract Type: Original Research
Background: The incidence of labor epidural failure ranges from 0.9% to 24%, resulting in maternal dissatisfaction and potential poor fetal outcome. We conducted this study to analyze and identify the incidence of failed labor epidurals, the causes of failure and the risk factors associated with epidural catheter failure.
Methods: We identified all patients who had failed labor epidural analgesia and received catheter replacement in 2017 as the "Replacement group"; we randomly selected 240 parturients who received single epidural placement in 2017 who delivered successfully as the "Control group". Parturients’ demographical data and characteristics data such as the time period elapsed between the 1st and 2nd epidural placement, total number of top-ups before replacement, anesthesiologist's training level, and reasons for replacement were analyzed. Fisher’s exact test and Wilcoxon rank-sum test were used for analysis.
Result: 111 parturients experienced inadequate pain relief and received replacement. The incidence of labor epidural replacement was 2.6% at our hospital. The total number of top-ups, cervical dilatation at the first placement, method of delivery were significantly different between two groups. Total number of top-ups was significantly higher in the replacement group (P<0.0001), while cervical dilatation was significantly shorter in the replacement group (P<0.00001). The incidence of failure-to-progress cesarean delivery was significantly higher in the replacement group compared to the control group (P=0.0007). There were no significant differences between these two groups in terms of anesthesiologist’s training level, interspace used for the 1st placement and distance of 1st LOR. 83.8% of epidural replacements were replaced due to uncontrolled pain; 10.8% of the replaced catheter was because of unsatisfactory level of coverage for cesarean delivery.
Discussion: Compared to the historical data at the same institution, there was a significant reduction of epidural failure rate from 13.1% in 1995 to 2.6% in 2017. This could be attributed to the change of practice and improvement of equipment. The time period of from the initial placement to the epidural replacement implied large variance of causes for these non-functional epidural catheters. However, the training levels of anesthesiologists were not associated with epidural failure.
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