A Prospective Observational Study to Determine the Predictors of Increased Number of Attempts at Labour Epidural Placement.

Abstract

ObjectiveMultiple attempts at labour epidural placement result in patient discomfort and high incidence of complications. Identifying the factors that lead to more than one attempt would help anaesthesiologists prepare in advance such as getting expert help and additional equipment, patient counselling or planning alternative management.MethodsThis prospective observational study was conducted on 500 patients from July 2017 to June 2018 after obtaining approval from the institutional Ethics Review Committee. The study patients consisted of full-term parturient women who were admitted in the labour room suite of Aga Khan Hospital requesting for labour epidural and consented to participate in the study. A predesigned form was used to collect the following data: number of attempts at epidural insertion and factors such as patients’ demographics, cervical dilatation, anatomical grading of spine according to visibility and palpation of spinous process and vertebral interspace, experience level of the anaesthesiologist, patient satisfaction and pain score during labour.ResultsThe average age of the patients was 28.11±4.02 years. The total number of epidural attempts varied between one and four; the median number of attempts was 1 [IQR=1–2]. Anatomical grade of the spine was the only factor that was significantly associated with more than one attempt at epidural insertion (p=0.0005). Patient satisfaction was negatively associated with the number of attempts (p=0.04), but mean pain difference at different time points during the course of labour was not statistically significant between patients with one attempt and those with more than one attempt.ConclusionDetermining the anatomical grade of the spine is the most reliable method for predicting a technically difficult neuraxial block that requires more than one attempt at epidural insertion.