Time to Get Comfortable with a Labour Epidural

Abstract

Women frequently request regional analgesia during labour, yet little is known about how long it takes before they become comfortable. This prospective observational study aimed to determine various time-points following maternal request for regional analgesia in labour until comfort was achieved. It was conducted in two tertiary referral centres for maternity care in Australia between December 2009 and May 2010. Midwives and anaesthetists recorded times of maternal request for regional analgesia, anaesthetist contact, anaesthetist's arrival in the labour room, local anaesthetic infiltration on starting the procedure, injection of neuraxial local anaesthetic and first report of maternal comfort. Composite median times and interquartile range were recorded for maternal request to anaesthetist arrival, anaesthetist arrival to maternal comfort and total time from request to comfort. Statistical modelling and regression analyses assessed possible factors associated with these time intervals. A P value <0.05 was considered significant. Of the 324 maternal requests, 244 out of 324 (75.3%, 95% confidence interval 70.2% to 79.9%) were recorded as having achieved satisfactory labour analgesia. Median interquartile range times observed were: maternal request to anaesthetist arrival: 20 (10 to 35) minutes; anaesthetist arrival to maternal comfort: 40 (30 to 50) minutes; and total time from request to comfort: 65 (50 to 85) minutes. We have shown that approximately one hour is required for a mother to achieve comfort following her request for epidural analgesia during labour. Our findings are likely to provide useful information for antenatal education, enhance informed consent and improve the provision of anaesthetic services for labour analgesia.

Taken as Read but Not Cited

“…It is enlightening to revisit these non-cited articles to assess their individual merit. Twelve of the 30 articles were clinical reports on a range of topics: airway management in patients with retrosternal goitre 2 , hydroperoxide concentrations in cardiac surgical patients 3 , diabetic status and haemofiltration requirements 4 , magnetic resonance imaging and core body temperature 5 , statins and insulin requirements 6 , glycaemic control and long term outcomes 7 , sterile water treatment of hypernatraemia 8 , caudal analgesia for circumcision 9 , anaesthetic techniques and immune responses 10 , epidural request to comfort intervals 11 , dexmedetomidine for short procedures 12 , and parecoxib and paracetamol for minor day-stay surgery 13 . Two were clinical audits: one on anaesthesia-related haemodynamic complications in patients with Williams syndrome 14 and the other on adequacy of intraoperative echocardiographic images 15 .…”

Interprofessional provider attitudes toward the initiation of epidural analgesia in the laboring patient: are we all on the same page?

“…Assuming no contraindications are present, labor epidural analgesia should ultimately depend on patient preference, although provider attitudes and biases may also influence the patient's decision-making. Given the severity of labor pain 12 and the time taken for a patient to become comfortable after epidural initiation, 13 interprofessional co-operation and timely communication are paramount. 14 Interdisciplinary attitudes toward the timing of epidural placement would ideally be congruent, however it is uncertain if different providers prioritize different factors when counseling patients.…”