Survey of the Practice of Epidural Analgesia in a Regional Sample of Obstetric Units

Abstract

,411 inoc.stigution into prcictices of' th[. epidurul services in a regionul sarnple of' obstetric units IVLIS undertakrn ,fijllowing reciwt reported dkasters associated with epidural analgesia for labour pain. A questionnaire ~c'as completed by all 22 obstetric* units in thc region, which included .six teaching. 14 district and two independent centres. In three units the epidural swviee was sliurucl with the obstetricians. A continuous unaesthetic presence wus provided in 16 of' 22 units. There M.'US consiileruble variation in the uttrndunce u p n epidural patients bv the unaesthetists. Instructions to rnidk$*ives ,for top-ups and subsequent core of puticnts ,follo~retl no uniform pattern. Midhi@e in-service training in tlzr initial munagenzrnt of' ,rcriou.s. epidural r.otnplii~ution.r nnd in c~irdio~piclmoiiar~~ resuscitation bt'us inconsistent. h some units, the uvoidance (if aortocaval compression as not emphusised in the nianugement of serious complications such as severe maternal kj)pvtension, totul spinal blockode or curdim arwst of' tliv parruricnt. Thc results obtained in this survey suggesst that there is u nerd to review rhr requirements in thc prori.rion of ohstctric c~piiluriil scv-vices and considerut ion sliould be given to the estahli.rhmcnt of a Rtwrully accepted stanu'md of practice.