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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

The Influence of an International Teaching Program on the Use of Spinal Analgesia for Labor and Regional Anesthesia for Cesarean Section in a Bosnian Obstetric Hospital

Abstract Number: S3A-3
Abstract Type: Original Research

Ivan Velickovic M.D.1 ; Joanna Serafin PhD2; Oleg Turkot M.D.3; Denis Odobasic M.D. Prim.4; Dzenita Ljuca M.D. Prof.5; Senida Keser M.D. Prim.6

Introduction: University Clinical Center Tuzla (UCCT) is the largest Clinical Center in Bosnia, outside the capital Sarajevo, with approximately 3000 deliveries per year. Prior to Kybele visit, regional anesthesia (RA) and analgesia techniques were not used at Labor and Delivery unit. Members of the Department of Anesthesia at UCCT, requested a multi-year Kybele program in 2016 to help train physicians in the use of RA techniques for labor and Cesarean Section (CS). This study updates the efforts of Kybele and UCCT physicians to increase obstetric RA use.

Method: In April and September 2017, a Kybele team, visited UCCT for 5 and 5 days respectively to conduct training in RA for CS and neuraxial analgesia for labor (NAL). The data were retrospectively collected on the use of RA for CS and on the use of spinal, epidural/CSE and intravenous analgesia for labor for the period of January 1st, 2017 to December 31st, 2017.

Results: The monthly and annual use of RA for labor is shown in the Figure 1. In the months prior to the Kybele visit 0 NAL were done per month. After the Kybele visit 14-34 single shot spinal (SSS) for labor were done per month. After the second visit, local physicians stared performing CSE for labor. A total of 218 patients had NAL for labor during 2017. Thirteen RA administrations were performed for CS during 2017. The trend across visits indicates increasing RA use over time, both for CS and for labor.

Discussion: Prior to our visit, only two faculty members had very limited experience with NAL and RA for CS. Our efforts during first visit resulted in creation of labor analgesia service. Single shot spinal analgesia was very well accepted by patients and obstetricians. Majority of the faculty is now comfortable with SSS for labor. During the second visit we concentrated on epidural/CSE and faculty members expressed willingness to learn these techniques. After the second visit, two faculty members started performing CSEs.

Conclusion: Single shot spinal analgesia is an excellent option for labor analgesia where there is limited or no experience with epidural/CSE analgesia. There remains limited availability of trained anesthesiologists and a lack of patient education on the benefits of RA and NAL. Future Kybele team visits will concentrate on training faculty on the use of epidural/CSE for labor and RA for CS. Plans are made to invite practitioners beyond UCCT (Sarajevo) to increase RA and NAL utilization across the country.



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