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Labor Epidural Catheter Reactivation for Postpartum Tubal Ligation
Abstract Number: T2H-376
Abstract Type: Original Research
Background: There are multiple anesthetic options for postpartum tubal ligation (PPBTL) after vaginal delivery. A labor epidural can be left place until the BTL and dosed with local anesthetic to achieve a surgical level. However, re-activating epidural catheters that have not been running is not always successful, and the timing of PPBTL on the labor and delivery floor is variable. Shorter delivery to PPBLT intervals are generally needed to achieve high epidural success rates, with success rates of as high as 80% reported even after 24 hours. (1) On our labor and delivery unit, epidural catheters may remain in place and unused for over 24 hours before the procedure is performed. However, our actual rate of epidural success is uncertain when the catheter has remained in place but unused for this period of time.
Methods: Following Institutional Review Board approval, retrospective and prospective data was collected on patients who had labor epidurals and subsequent PPBTL. Information collected included baseline demographics, time of epidural placement, time of infusion cessation, time of dosing for PPBTL, success of the epidural as surgical anesthetic for PPBTL, and further details about the anesthetic used for the procedure.
Results: Data from 144 patients was collected. Overall, 83 epidurals (58%) were successfully used as the primary anesthetic for PPBTL and 61 (42%) were unsuccessful. For each category (time epidural was turned off and time epidural in place), data was grouped into 4-8 hour windows. For epidurals turned off for <12 hours (n=80, 56%), the successful reactivation rate was 70%. For epidurals turned off > 12 hours (n=64, 44%), the successful reactivation rate was 42.2%. Epidurals that had been in place for <16 hours or less (regardless of infusion time) had a successful reactivation rate of 71%, while epidurals that had been in place for > 16 hours had a successful reactivation rate of 45%. Insufficient dermatomal level was the most common reason the epidural was not able to be used as the primary anesthetic. General anesthesia was the most commonly used backup anesthetic.
Discussion: Our epidural reactivation rate is overall lower than previously published reports. As expected, the greater the time the epidural remains unused, the less likely it is to be a successful primary anesthetic for a PPBTL. There is a drop off in success rate after 12 hours of non-use and after 16 hours of total epidural time. The reasons for this are unclear as many of the unsuccessful epidurals seem to remain in the epidural space but do not provide an adequate surgical level.
Conclusion: Data on this topic has aided our ability to counsel patients on their anesthetic options and surgical planning for PPBTL following vaginal delivery.
1. Goodman, EJ at al “The rate of successful reactivation of labor epidural catheters for postpartum tubal ligation surgery” Reg Anesth Pain Med 1998;23(3):258-261