Abstract
Background: Use of an in situ epidural catheter has been suggested to be efficient to provide anesthesia for postpartum tubal ligation (PPTL). Reported epidural reactivation success rates vary from 74% to 92%. Predictors for reactivation failure include poor patient satisfaction with labor analgesia, increased delivery-to-reactivation time and the need for top-ups during labor. Some have suggested that this high failure rate precludes leaving the catheter in situ after delivery for subsequent reactivation attempts. In this study, we sought to evaluate the success rate of neuraxial techniques for PPTL and to determine if predictors of failure can be identified. Methods: After obtaining IRB approval, a retrospective chart review of patients undergoing PPTL after vaginal delivery from July 2010 to July 2016 was conducted using CPT codes, yielding 93 records for analysis. Demographic, obstetric and anesthetic data (labor analgesia administration, length of epidural catheter in epidural space, top-up requirements, time of catheter reactivation, final anesthetic technique and corresponding doses for spinal and epidural anesthesia) were obtained. Results: A total of 70 patients received labor neuraxial analgesia. Reactivation was attempted in 33 with a success rate of 66.7%. Patient height, epidural volume of local anesthetic and administered fentanyl dose were lower in the group that failed reactivation. Overall, spinal anesthesia was performed in 60 patients, with a success rate of 80%. Conclusions: Our observed rate of successful postpartum epidural reactivation for tubal ligation was lower than the range reported in the literature. Our success rates for both spinal anesthesia and epidural reactivation for PPTL were lower than the generally accepted rates of successful epidural and spinal anesthesia for cesarean delivery. This gap may reflect a lower level of motivation on behalf of both the patients and anesthesia providers to tolerate "imperfect" neuraxial anesthesia once fetal considerations are removed.
Highlights
Tubal ligation in the immediate postpartum period, postpartum tubal ligation (PPTL), is typically performed on the labor ward, but less than 50% of women that desire PPTL receive the procedure in the immediate postpartum period, despite The American College of Obstetricians and Gynecologists (ACOG) defining PPTL as an urgent procedure due to the limited optimal surgical timeframe[1]
This study evaluated the frequency of success at our center using the aforementioned anesthetic techniques for PPTL and sought to determine if there are clinical success predictors that can aid in anesthetic decision-making
Data collection Data collected for each case included demographic data, obstetric data and anesthetic data
Summary
Tubal ligation in the immediate postpartum period, postpartum tubal ligation (PPTL), is typically performed on the labor ward, but less than 50% of women that desire PPTL receive the procedure in the immediate postpartum period, despite The American College of Obstetricians and Gynecologists (ACOG) defining PPTL as an urgent procedure due to the limited optimal surgical timeframe[1]. Do the authors have a citation to support the statements “Within our practice, and sometimes in the broader obstetric anesthesia community, providers have suggested that rates of failure when attempting catheter “reactivation” for PPTL do not support the practice leaving a labor epidural catheter in place for an interval PPTL. Instead, these providers advocate the routine removal of the epidural catheter followed by a de novo spinal anesthetic (SA)”?. This gap may reflect a lower level of motivation on behalf of both the patients and anesthesia providers to tolerate “imperfect” neuraxial anesthesia once fetal considerations are removed
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