Failure rate of labor epidural

Abstract

Context: Frequent use of labor epidural has also led to a corresponding increase in failed epidural analgesia (FEA). Aims: This study aims to identify the overall rate of FEA and evaluate its association with trainee anesthesiologist at different years/levels of anesthesia residency training. Settings and Design: Prospective observational study was conducted for one year in the labor room suit of a university hospital. Methods and Material: After university ethics committee approval, full-term parturient receiving labor epidurals and consenting for the study were included. FEA was identified by the presence of one or more set criteria of failure including; pain of numeric rating scale of >4 at 45 minutes after epidural placement, accidental dural puncture, need to re-site the epidural, abandoning the procedure, and maternal dissatisfaction with labor pain relief. Statistical Analysis Used: A binary logistic regression was used to assess the association between failure rate of labor epidural and grades of anesthesiologists. Odds ratio (OR) and 95% confidence interval (CI) were reported. P value ≤0.05 was considered significant. Results: Out of 500 women included, 76 (15.2%) had FEA, which was significantly high in 2 nd and 3 rd year residents compared to 5 th year and above level anesthesiologists [OR = 2.08; 95% CI: 1.17 to 3.67; P = 0.012]. Failure rate was also high but insignificant in 4 th year residents compared to senior level anesthesiologists [OR = 1.78; 95%CI: 0.89 to 3.53; P = 0.098]. Conclusions: The incidence of FEA is comparable to those quoted in literature from developed countries and shows association to experience and year of training of anesthesia residents.

Needle guidance with Doppler-tracked polarization-sensitive optical coherence tomography

“…The plethora of guidance tools currently under development may help to facilitate nerve block administration in emergency settings, lowering the level of experience needed to perform the procedure successfully. 38,39 We believe that needle-based PS-OCT has a high potential to be miniaturized and could be of value also in scenarios where the form factor must be small. As a step toward this goal, we have demonstrated that a simple probe without any scanning or focusing optics is sufficient for layer identification.…”

“…proposed an optical measurement of the force applied to the tip of the needle as it passes through each layer using a fiber-Bragg grating 36 , 37 and work is currently ongoing to create a biocompatible version of this probe. The plethora of guidance tools currently under development may help to facilitate nerve block administration in emergency settings, lowering the level of experience needed to perform the procedure successfully 38 , 39 …”

“…The plethora of guidance tools currently under development may help to facilitate nerve block administration in emergency settings, lowering the level of experience needed to perform the procedure successfully. 38 , 39 …”