Incidence of epidural catheter replacement in parturients: a retrospective chart review

Eappen, Sunil; Blinn, A.; Segal, Scott

doi:10.1016/s0959-289x(98)80042-3

Cited by 112 publications

(68 citation statements)

References 11 publications

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“…The success rate of this simple intervention is much higher than the 56% success rate previously reported. 23 The retrospective review undertaken by Eappen et al 23 identified 153 cases of ELA in which the catheter was pulled back 0.5 to 1.0 cm in an attempt to improve ELA. Perhaps the higher success rate reported in our review was the result of the routine practice in our institution of pulling the catheter back a minimum of 1.0 cm.…”

Section: Discussionmentioning

confidence: 99%

“…Perhaps the higher success rate reported in our review was the result of the routine practice in our institution of pulling the catheter back a minimum of 1.0 cm. Unfortunately, Eappen et al 23 did not report the number of the cases in which the catheter was pulled back only 0.5 cm; therefore, a comparison of the efficacy of the intervention of pulling the catheter back 0.5 cm vs. 1.0 cm cannot be made.…”

Section: Discussionmentioning

confidence: 99%

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Conversion d’une analgésie péridurale pour travail obstétrical en une anesthésie péridurale pour césarienne

Campbell

Tran

2008

Can J Anesth/J Can Anesth

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Purpose To determine the rate of successful conversion of epidural labour analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum Cesarean delivery (CD) with identification of potential risk factors for inadequate ESA. Secondary outcomes include a comparison of the management by subspecialist obstetric anesthesiologists (OB) vs. generalist anesthesiologists (GEN), when inadequate ESA was encountered, with an intention of identifying potential interventional strategies to reduce the need for general anesthesia (GA). Methods Health records of all parturients who received ELA and who underwent intrapartum CD during the 3-year period from April 01, 2001 to March 31, 2004 were manually reviewed. Data were analyzed using t test, Chisquare, Fisher's exact test, and analysis of variance where appropriate. A P \ 0.05 was considered significant. Results Eight hundred ninety-nine cases were identified. Four were excluded, as two received continuous spinal labour analgesia and two underwent emergency CD with insufficient time for conversion to ESA. Initially, 86.6% (775/895) of the 895 cases were successfully converted to ESA leaving 120 cases of inadequate ESA, 36 of these were managed by OB and 84 by GEN. Ineffective ELA was identified as a risk factor for unsuccessful conversion. Pulling the epidural catheter back 1 cm was identified as an effective intervention that resulted in the successful conversion in [80% of the 120 cases of inadequate ESA.Spinal anesthesia proved effective in 75% of cases. Both interventions reduced the need for GA to 1.2% for OB and 5.6% for GEN. Conclusions This investigation provides anesthesiologists with strategies to manage inadequate ESA for intrapartum CD that may reduce the need for GA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Conversion d’une analgésie péridurale pour travail obstétrical en une anesthésie péridurale pour césarienne

Campbell

Tran

2008

Can J Anesth/J Can Anesth

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“…1 In a large cohort study in non-obstetric subjects, up to a 27% failure rate for lumbar epidural has been described, 2 while in labour epidural analgesia, a 1.5-23% failure rate has been reported. 3,4 The correct placement of the epidural catheter therefore remains a clinical concern. Currently, there is no available bedside imaging technique that can determine the exact position of the epidural catheter.…”

Section: Résumémentioning

confidence: 99%

The epidural electric stimulation test does not predict local anesthetic spread or consumption in labour epidural analgesia

Margarido

Dlacic

Balki

et al. 2013

Can J Anesth/J Can Anesth

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Purpose The epidural electrical stimulation test (EEST) is a highly specific and sensitive test for confirming placement of the epidural catheter in the epidural space. The purpose of this study was to investigate if the EEST could predict the spread and consumption of local anesthetic solutions during labour epidural analgesia. Methods This observational study was conducted in labouring parturients requesting epidural analgesia. The EEST was performed after the epidural catheter placement (T0) and repeated five minutes after a test dose with 2% lidocaine 3 mL (T1). The minimum current required to elicit the motor response at each time point was recorded.A loading dose of 0.125% bupivacaine 10 mL and fentanyl 50 lg was administered and followed by patient-controlled epidural analgesia with 0.0625% bupivacaine and fentanyl 2 lgÁmL -1 (baseline infusion 10 mLÁhr -1 , bolus dose 5 mL, lockout interval ten minutes, maximum dose 20 mLÁhr -1 ). The primary outcome was the correlation between the current required to elicit motor responses at T0 and T1 and the consumption of bupivacaine in the first two hours of epidural administration. The secondary outcomes included the muscle contraction patterns determined by the EEST and the incidence of failed, inadequate, or asymmetric blocks. Results The study was conducted in 102 parturients. The mean electric current required to elicit muscle response was 4.43 mA (range 1-10 mA) at T0, 5.97 mA (range 1-14 mA) at T1, and the mean D (T1-T0) current was 1.54 mA (range 0-8 mA). There was no correlation between either the mean baseline current required or the D (T1-T0) current and the total bupivacaine consumption at two hours. The incidence of inadequate blocks at two hours was 18%; however, none of the catheters required replacement. Unilateral left (34%) or right (31%) leg contraction was the most frequent pattern elicited by the EEST. Conclusions The EEST shows a wide range of electrical current requirements and elicits a variety of muscle twitch patterns on the lower limbs. Although it confirms the epidural placement of the catheter, the EEST cannot be used to predict the spread or consumption of the local anesthetic solution during labour epidural analgesia. RésuméObjectif Le test de stimulation e´lectrique pe´ridurale (TSEP) est un test extreˆmement spe´cifique et sensible qui

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“…A very low failure rate of 0.5-0.8% was reported by Norris et al (2001) in a randomised prospective study including 2183 parturients receiving either CSE or EDA, with no difference between the two methods. In another setting, in a large retrospective study including 3233 vaginal deliveries the epidural replacement rate was 12.1% (Eappen et al 1998). If more precise criteria are applied on whether the epidural fails, a higher incidence is noted.…”

Section: Analgesia With Remifentanil Epidural Block and Nitrous Oxidementioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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Incidence of epidural catheter replacement in parturients: a retrospective chart review

Cited by 112 publications

References 11 publications

Conversion d’une analgésie péridurale pour travail obstétrical en une anesthésie péridurale pour césarienne

Conversion d’une analgésie péridurale pour travail obstétrical en une anesthésie péridurale pour césarienne

The epidural electric stimulation test does not predict local anesthetic spread or consumption in labour epidural analgesia

Intravenous patient-controlled analgesia with remifentanil in early labour

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