Abstract
BackgroundLoss of resistance (LOR) technique is a widely used method to identify the epidural space. However, cases of inadequate epidural anesthesia in cesarean section were frequently reported. Also, the success rate of epidural anesthesia with LOR technique varied depending on the proficiency of the practitioner. The purpose of this study was to assess the efficacy and safety of electrical stimulation to identify epidural spaces in cesarean section for novices or clinicians with recent gap in experience.MethodsPregnant women scheduled for elective cesarean section were randomly allocated to two groups. Groups were classified based on the methods used for identifying the epidural space: the LOR group (group L) and the LOR with epidural electrical stimulation group (group E). Clinicians with less than 10 epidural cesarean section experiences in the recent year performed epidural anesthesia for cesarean section. In the group E, a RegionalStim® conductive catheter was inserted through the Tuohy needle, and the guidewire passing through the catheter was connected to a peripheral nerve stimulator. The intensity of the stimulation was gradually increased from 0.25 mA to 1.5 mA until paresthesia was elicited and radiated. We assessed the success of epidural anesthesia (complete success, partial success or failure). Other clinical parameters including maternal satisfaction, time required for epidural anesthesia, neonatal Apgar scores, pain scores and adverse events were compared between the two groups.ResultsExcept for 6 patients who withdrew consent, 54 patients were enrolled in this study (28 for the group L and 26 for the group E). The demographic data showed no difference between the two groups. There was no adverse event resulted from electrical stimulation. The group E showed higher rate of complete success, sensitivity in finding epidural space and maternal satisfaction compared to the group L (21/26 vs. 15/28, p = 0.034, 0.96 vs. 0.68, p = 0.012 and 4.04 vs. 3.39, p = 0.02, respectively). The other clinical parameters showed no differences between the two groups.ConclusionIn addition to the conventional LOR technique, identifying epidural spaces using electrical stimulation led to better outcomes without additional risks for novices as well as clinicians with recent gap in experience.Trial registrationThis study was retrospectively registered in the ClinicalTrials.gov Registry (NCT03443466) on February 23, 2018.
Highlights
Loss of resistance (LOR) technique is a widely used method to identify the epidural space
Spinal anesthesia appeared to be preferred over epidural anesthesia in the cesarean section [4]
We have previously shown the utility of electrical stimulation-guided epidural analgesia for vaginal delivery [9]
Summary
Loss of resistance (LOR) technique is a widely used method to identify the epidural space. The success rate of epidural anesthesia with LOR technique varied depending on the proficiency of the practitioner. Epidural analgesia and anesthesia are widely used in the obstetrical area. In labor, the usefulness of epidural analgesia is remarkable [1]. In the cases for cesarean section, epidural anesthesia demonstrated many advantages than other anesthetic techniques especially for the parturient with congenital heart disease [3]. When converting epidural labor analgesia into surgical anesthesia for cesarean section, the rate of conversion failure has been reported up to almost 20% [5]. The rate of failed epidural anesthesia conversion was 4.5 times higher for non-specialist anesthesiologists than among obstetric anesthesiologists [6]
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