The relationship between resited epidural catheters after secondary epidural catheter failure and vaginal delivery: A retrospective case‐control study

Abstract

Background There are cases where epidural analgesia is initially effective but subsequently fails and needs to be resited. We evaluated the rate of normal vaginal delivery and operative delivery among parturients who had resited epidurals compared to parturients with epidurals that were not resited. Methods A retrospective electronic medical review of parturients with a singleton gestation attempting normal vaginal delivery under epidural analgesia between the years 2012‐2016 was conducted. Resited epidurals were defined as epidurals that were considered effective but subsequently removed and reinserted. For each resited epidural, two previous and two consecutive deliveries of parturients with normally functioning epidural catheter inserted by the same anesthesiologist were matched controls (non‐resited epidurals). Results There were 35,984 attempted vaginal deliveries with 118 resited epidurals and 472 non‐resited epidurals. When adjusted for nulliparity, oxytocin administration, sex and weight of the baby, and maternal BMI, labor epidural catheter replacement was not associated with need for instrumental or caesarean delivery, (OR 1.5, 95% CI 0.91‐2.49, P = .11). Conclusions Need for labor epidural catheter replacement does not appear to be associated with need for operative delivery based on this single‐centre cohort analysis.

The Effectiveness of Intraoperative Thoracic Epidural Analgesia in Major Abdominal and Thoracic Surgery and Its Prediction of Severe Pain at Discharge from the Post-Anesthetic Care Unit: A Prospective Cohort Study

“…First, several terms are commonly used to described iTEA, e.g., TEA failure, inadequate TEA, and insufficient TEA 13,14,23 . Second, the definition of iTEA varies between studies; such definitions include 1) an acceptable level of pain control was not achieved 14,16 , 2) inability to locate the sensory blockade after epidural bolus injection [26][27] , and 3) any reasons causing the premature removal of the epidural catheter 16,28 or the need for epidural catheter re-insertion 26 . TEA failure can be classified into primary and secondary causes.…”