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The Influence of an International Teaching Program on the Use of Spinal Analgesia for Labor and Regional Anesthesia for Cesarean Delivery in Tuzla, Bosnia and Herzegovina
Abstract Number: T2C-250
Abstract Type: Original Research
Introduction: University Clinical Center Tuzla (UCCT) is the second largest Clinical Center in Bosnia, 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 Delivery (CD). This study updates the efforts of Kybele and UCCT physicians to increase obstetric RA use.
Method: In April and September 2018, a Kybele team, visited UCCT for 5 and 5 days respectively to conduct training in RA for CD and neuraxial analgesia for labor (NAL). The data were retrospectively collected on the use of RA for CD and on the use of NAL for the period of January 1st, 2018 to December 31st, 2018.
Results: The monthly and annual use of RA for labor and CD is shown in the Figure 1. A total of 221 patients had NAL for labor during 2018, comparable to 218 in 2017. Also, a total of 119 RA were done for CD an increase of 915% comparing with 2017. The trend across visits indicates increasing RA use over time, for CD and no change in use of RA for labor. Majority of the faculty is now comfortable with single shot spinal (SSS) for labor and increasing number of faculty members are comfortable with spinal anesthesia for CD.
Discussion: Our efforts during first visit resulted in creation of labor analgesia service. During the second visit we concentrated on epidural/CSE and faculty members expressed willingness to learn these techniques. During the third and fourth visit we concentrated on spinal anesthesia for CD.
Conclusion: SSS analgesia is an excellent option for labor analgesia where there is limited or no experience with epidural/CSE analgesia. SSS analgesia was very well accepted by patients and obstetricians. Spinal anesthesia for CD was also very well accepted among patients and obstetricians. There remains limited availability of trained anesthesiologists and obstetricians and lack of patient education on the benefits of RA and NAL. The local team has started education sessions for their patients about the benefits of RA for labor and NAL for CD. Future Kybele team visits will concentrate on training additional faculty on the use of epidural/CSE for labor and RA for CD. Plans are made to invite practitioners beyond UCCT (Zenica) to increase RA and NAL utilization across the country.