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Incidence of failure of resited epidurals in laboring parturients
Abstract Number: T5D-2
Abstract Type: Original Research
INTRODUCTION:The risk factors for and appropriate management of primary epidurals in laboring women has been extensively studied and described in the literature. In a study of 19,259 laboring women the overall failure rate was approximately 12%.(1) Management of a failed epidural may include resiting the epidural and re-exposing the laboring patient to risk with minimal published literature on the expected success rate of the repeated procedure. It cannot be assumed that the failure rate of a resited epidural is the same as the primary epidural. This study aims to define the incidence of failure of resited epidurals.
METHODS:We conducted a prospective cohort study to assess the incidence of failure of resited epidurals at two institutions. Our secondary objective was to assess patient and procedure factors that may impact failure rates. Following a waiver of consent, women admitted in labor for an intended vaginal delivery who received a resited labor epidural for primary epidural failure were enrolled. A study survey was completed by the anesthesia provider and bedside nurse at the time of the epidural resite and after delivery. Patient and nurse satisfaction with the resited epidural was recorded and additional data was extracted from the patient chart. If either the patient or nurse was unsatisfied with the resited epidural, then it was considered a failure. We performed data analysis using descriptive statistics and univariate analyses.
RESULTS:A total of 30 patients were enrolled between February and December 2017. 27 surveys were completed with patient and nurse satisfaction. The incidence of resited epidural failure was 8/27 (29.6%; 95% CI: 12.4,46.9). The incidence of epidural resite failure was 1/14 if the primary epidural placement was performed by a junior anesthesia resident, compared to 7/13 if performed by a senior anesthesia resident or staff anesthesiologist (p=0.009). There was a trend towards increased failure of the resited epidural if performed by a senior resident (6/11) when compared to a staff anesthesiologist (1/9, p=0.084). Resited epidurals had increased failure if the primary epidural had a long duration with an average running time of 7.8 hours (4.3-10.5) versus a short duration of 2.2 hours (1.3-5.0, p=0.004).
CONCLUSION:Clinician factors that may improve the success rate of the resited epidural include if the primary epidural placement was by a junior resident and if the resited epidural is performed by a staff anesthesiologist. Epidural resite failure is more likely if the primary epidural has been running for a long duration. Finally, the measured incidence of resited epidural failure at the two institutions was approximately 30%. Given the significant discrepancy between this and the 12% primary epidural failure rate quoted by Pan et al, this small preliminary study suggests that further research is needed to further elucidate the risk factors for epidural resite failure.
1.Pan et al.IJOA.2004;13(4):227-233