The causes and remedial measures of the failure of continuous epidural block for labor analgesia

Abstract

Objective To investigate the causes and remedial measures of the failure of continuous epidural for labor analgesia. Methods Nine hundred and fifty-two primiparas who received voluntary labor analgesia were selected. They received epidural block in the L2- 3 interspace, and epidural catheter was inserted 4 cm into the epidural space. The method of labor analgesia was continuous intravenous injection combined with self controlled analgesia. The visual analogue score (VAS) >5 scores was analgesia failure. Withdrawing the epidural catheter 1 to 2 cm and replacement of the catheter or changing to subarachnoid space combined with epidural block was used to rescue the analgesia failure. The production process progress and satisfaction rate of postpartum 24 h were recorded. Results The analgesia failure was in 144 cases, and the analgesia failure rate was 15.1% (144/952), among which the epidural catheter was inserted into blood vessels in 47 cases, the epidural catheter was blocked by a blood clot in 13 cases, the epidural catheter bent in 9 cases, the unilateral block or partial block was in 31 cases, the epidural catheter migrated in 37 cases, the catheters left the epidural cavity in 5 cases, and dural puncture was in 2 cases. Eighty-seven cases were treated by withdrawing the epidural catheter 1 to 2 cm, 48 cases were treated by replacement of the catheter, and 9 cases were treated by changing to subarachnoid space combined with epidural block. The satisfaction rate of postpartum 24 h was 96.7% (921/952). Conclusions The failure of continuous epidural block for labor analgesia is higher. According to the different causes, the most of the failures could be rescued by withdrawing the epidural catheter 1 to 2 cm, replacement of the catheter or changing to subarachnoid space combined with epidural block. Key words: Analgesia, epidural; Parturition; Sufentanil; Ropivacaine