Abstract
BackgroundEpidural catheter re-siting in parturients receiving labour epidural analgesia is distressing to the parturient and places them at increased complications from a repeat procedure. The aim of this study was to develop and validate a clinical risk factor model to predict the incidence of epidural catheter re-siting in labour analgesia.MethodsThe data from parturients that received labour epidural analgesia in our centre during 2014–2015 was used to develop a predictive model for epidural catheter re-siting during labour analgesia. Multivariate logistic regression analysis was used to identify factors that were predictive of epidural catheter re-siting. The forward, backward and stepwise variable selection methods were applied to build a predictive model, which was internally validated. The final multivariate model was externally validated with the data collected from 10,170 parturients during 2012–2013 in our centre.ResultsNinety-three (0.88%) parturients in 2014–2015 required re-siting of their epidural catheter. The training data set included 7439 paturients in 2014–2015. A higher incidence of breakthrough pain (OR = 4.42), increasing age (OR = 1.07), an increased pain score post-epidural catheter insertion (OR = 1.35) and problems such as inability to obtain cerebrospinal fluid in combined spinal epidural technique (OR = 2.06) and venous puncture (OR = 1.70) were found to be significantly predictive of epidural catheter re-siting, while spontaneous onset of labour (OR = 0.31) was found to be protective. The predictive model was validated internally on a further 3189 paturients from the data of 2014–2015 and externally on 10,170 paturients from the data of 2012–2013. Predictive accuracy of the model based on C-statistic were 0.89 (0.86, 0.93) and 0.92 (0.88, 0.97) for training and internal validation data respectively. Similarly, predictive accuracy in terms of C-statistic was 0.89 (0.86, 0.92) based on 2012–2013 data.ConclusionOur predictive model of epidural re-siting in parturients receiving labour epidural analgesia could provide timely identification of high-risk paturients required epidural re-siting.
Highlights
Epidural catheter re-siting in parturients receiving labour epidural analgesia is distressing to the parturient and places them at increased complications from a repeat procedure
In a retrospective cohort study conducted in our centre from 2012 to 2013, the incidence of epidural catheter re-siting in parturients with epidural labour analgesia was found to be 0.85% [4]
We identified independent association factors that were associated with epidural catheter re-siting, which included a greater quantity of dinoprostone (Prostin E2) used for induction of labour, a longer time taken to perform the neuraxial blockade, a higher incidence of breakthrough pain, requirement for Caesarean section for delivery and complications associated with epidural analgesia such as venous puncture as well as hypotension and shivering [4]
Summary
Epidural catheter re-siting in parturients receiving labour epidural analgesia is distressing to the parturient and places them at increased complications from a repeat procedure. A poorly functioning epidural catheter that does not provide adequate pain relief may require a repeat invasive procedure for re-siting This would lead to further distress to the parturient and may place them at additional risk for complications from another epidural catheter placement [4]. We identified independent association factors that were associated with epidural catheter re-siting, which included a greater quantity of dinoprostone (Prostin E2) used for induction of labour, a longer time taken to perform the neuraxial blockade, a higher incidence of breakthrough pain, requirement for Caesarean section for delivery and complications associated with epidural analgesia such as venous puncture as well as hypotension and shivering [4]. The area under curve (AUC) of the receiver operating characteristic (ROC) curve for this multivariate model was 0.894
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