Practice Of Epidural Analgesia Research Articles

Trends in Practice and Safety Measures of Epidural Analgesia: Report of a National Survey

(Acta Anaesthesiol Scand. 2018;62:1466–1472) There is a trend to move away from neuraxial blocks in favor of truncal blocks, peripheral nerve blocks, and local anesthetic wound infiltration in the Netherlands. Furthermore, recent epidural “alert systems” have been introduced, meant to aid in the early detection of spinal hematoma or abscess after neuraxial anesthesia. However, these changes have not been investigated on a national level. The authors of the present study thus quantified trends in the practice of epidural analgesia and assessed the extent to which these epidural alert systems have been introduced in clinical practice.

Perceptions and practice of epidural analgesia among women attending antenatal clinic in FETHA.

BackgroundThe pain of childbirth is arguably the most severe pain that most women will endure in their lifetime. Epidural analgesia is widely used as an effective method of pain relief in labor. It provides almost complete relief of pain if administered timely, and does not affect the progress of the first stage labor.ObjectivesThe objective of this study was to determine the awareness and utilization of epidural analgesia in labor in pregnant women attending the antenatal clinic at Federal Teaching Hospital, Abakaliki (FETHA).MethodologyThis is a cross-sectional study involving 350 women attending the antenatal clinic between April 2016 and July 2016. A total of 335 questionnaires were correctly completed, and used for analysis.ResultsThe average age and parity of the respondents were 27.6±8.2 years and 2.4±1.8, respectively. About 58.2% of respondents were civil servants, 98.5% were married, and 74.6% had a tertiary level of education. About 43.3% of the respondents are aware of the use of epidural analgesia in labor, but only 7.5% had used it; 95% of these were satisfied and desired to use it again. The reasons responsible for the poor uptake were desire to experience natural labor, cost, and fear of side effects. However, 70% of those who had not used it expressed the desire to use it.ConclusionEpidural analgesia is one of the most effective methods of pain relief in labor. However, the present study indicates that knowledge and practice of epidural analgesia among parturients are low. Efforts should be made to raise awareness, dispel misconceptions, and subsidize the cost of providing this invaluable care in modern day obstetrics.

11: Current practice of epidural analgesia during normal labour: a telephone survey of maternity units

11: Current practice of epidural analgesia during normal labour: a telephone survey of maternity units

Current practice of epidural analgesia during normal labour: a telephone survey of maternity units

Current practice of epidural analgesia during normal labour: a telephone survey of maternity units

Epidural analgesia for labour pain: A review of availability, current practices and influence on labour

Summary We performed a review on the availability and current practice of epidural analgesia for labour pain and the influence of epidural analgesia on the outcome of labour. Recent surveys in North America and Europe have shown a trend towards increased labour pain management; no surveys from Africa, Asia, Australia or South America could be identified. Systemic medications remain the most common approach. In most countries, the use of epidural analgesia is steadily increasing with rates of between 14% and 38%, whereas in Hungary and two regions of Italy the epidural rate is below 5%. Twenty-four hour availability was reported more frequently at university hospitals or centres with a high delivery rate, than in smaller hospitals or rural areas. There is an increasing tendency in all countries, for epidural analgesia to be assigned to the responsibility of an anaesthetist. Recent developments, such as low concentrations of local anaesthetics and additional opioids, have become part of clinical practice in some European countries, although there is no data available from other countries, and there is no data on the use of ropivacine or sufentanil. The majority of midwives and obstetricians believe that epidural analgesia prolongs labour and 42% of midwives in the United States agreed that they should discourage its use. Current studies indicate an association between epidural analgesia and increased duration of labour, oxytocin augmentation, instrumental vaginal delivery, dystocia and Caesarean section. It remains unclear whether epidural analgesia causes abnormal labour or merely serves as a marker. Because epidural analgesia is only one of many factors influencing the course of labour, conclusions drawn from research centres may not necessarily apply to other institutions. Each individual hospital and its care providers should monitor their own statistics regarding epidural analgesia and intervention rates.

Patterns of Anesthesia in France Compared, 1980–1996. Clergue et al. (page 1509)

Clergue et al. collected and analyzed data from all French private, public, and military hospitals in 1996. Initiated by the Anesthesia Patient Safety committee of the French Society of Anesthesia, the survey was designed to analyze the growth and evolving patterns of use of anesthetic activity from 1980 to 1996. In collaboration with the French National Institute of Health and Medical Research, all anesthetics were documented and collected on questionnaires provided by study investigators for three consecutive days at each site.Investigators contacted anesthesiologists at every French hospital and created a regional steering committee in each of 30 regions to ensure full cooperation in the project. At the end of the 3-day survey at each institution, coordinating anesthesiologists collected all completed questionnaires from the anesthesiologists and submitted them to the INSERM office.In addition, 5% of all institutions in each region were randomly assigned to be audited. The rate of participation was high—98%. The analysis of 62,415 collected questionnaires allowed extrapolation of the anesthetic activity to 7,937,000 anesthetics performed in 1996, with a confidence interval of ± 387,000. The annual rate of anesthetics was 13.5 per 100 in the population, compared with 6.6 per 100 in 1980, an increase of 120%. Other observed trends included more anesthetics being used in patients ≥ 75 years of age and in patients with American Society of Anesthesiologists physical status III. The number of regional anesthetics increased 14-fold over the rate in 1980. In obstetrics, the practice of epidural analgesia had increased from 1.5% of all deliveries in 1980 to 51% of all deliveries in 1996. Because these values represent practice patterns in a highly developed nation with a sophisticated care delivery system, they should provide useful comparative information regarding practice patterns in many countries, including the United States.

French survey of anesthesia in 1996.

To identify the growth in the number of anesthetic procedures since 1980 and the changes in the practice of anesthesia, the present survey was designed to collect and analyze the anesthetic activity performed in France in 1996, from a representative sample collected in all French hospitals and clinics. This study, initiated by the French Society of Anesthesia and Intensive Care, collected information that included the characteristics of patients (age, sex, American Society of Anesthesiologists status), the techniques of anesthesia, and the nature of the procedure for which anesthesia was required. All French private, public, and military hospitals were asked to participate in the survey. In each hospital in the country, all anesthetic procedures were documented and collected during 3 consecutive days, chosen at random during a 12-month period, to obtain a representative sample of the annual activity. All data were analyzed at the INSERM (National Institute of Health and MEDICAL RESEARCH: At the conclusion of the study, 5% of hospitals were randomly assigned to be audited to check for missing data and errors. The rate of anesthetic activity was calculated as the ratio between the annual number of anesthetic procedures and the number of the general population in the same age group. The participation rate of hospitals was 98%. The analysis of the 62,415 collected questionnaires allowed extrapolation of the anesthetic activity to 7,937,000 anesthetic procedures (95% confidence interval, +/- 387,000) performed in France in 1996. Thus, the annual rate of anesthetic procedures was 13.5 per 100 population, varying between 5.4 per 100 in girls aged 5-14 yr and 30.2 per 100 in men aged 75-84 yr. Surgery was involved in 71% of anesthesia cases. Regional anesthesia alone was performed in 20% of all surgical cases and was combined with general anesthesia in 3% of additional cases. Anesthesia for obstetric procedures represented 9% of all cases. Seventy-six percent of all anesthetic procedures started between 12:00 A.M. and 7:00 A.M. were related to obstetric activities. In comparison with a previous study, the present survey shows that the number of anesthetic procedures has increased by 120% since 1980, and the rate of anesthetic procedures increased from 6.6 to 13.5 per 100 population, the major changes being observed in patients aged > or = 75 yr and in those with an American Society of Anesthesiologists physical status of 3. In the same time period, the number of regional anesthetic procedures increased 14-fold. In obstetrics, the practice of epidural analgesia extended from 1.5% to 51% of all deliveries of the country.

Practice of epidural analgesia for labour pain: a German survey

Epidural analgesia is one of the preferred methods of analgesia for labour. The aim of the present survey was to evaluate current practice in obstetric analgesia in departments of anaesthesia and to make a comparison with former surveys from Germany and other countries. Questionnaires on the practice of pain relief, especially epidural analgesia, during labour and delivery were sent to 1178 anaesthesic departments in Germany in the second half of 1996. Five hundred and thirty-two completed replies were received, which represent 46.9% of all German obstetric units. The majority of the departments of anaesthesia practising epidural analgesia have an epidural rate of less than 10% and 10.2% of the departments do not offer this method to their parturients. In 86.8% of all units performing epidural analgesia, the epidural catheter is placed by an anaesthetist. Only 6.5% of the units provide a 24-h epidural service which is exclusively assigned to labour and delivery. In 77.8% of the units, this service is not exclusively assigned to obstetrics, but also to other duties. Of the obstetric units offering epidural analgesia, 14.7% have no epidural service at night. Plain local anaesthetics for epidural analgesia are used by 55.9% of the departments, a combination of local anaesthetics with epidural opioids by 28.7%. Epidural analgesia is predominantly (82.2%) maintained by intermittent bolus administration. Although the rate of epidural analgesia increased during recent decades, this method is not offered to all parturients. Further improvements in the use of epidural analgesia for labour seem to be necessary.

Practice of epidural analgesia for labour pain: a German survey.

Epidural analgesia is one of the preferred methods of analgesia for labour. The aim of the present survey was to evaluate current practice in obstetric analgesia in departments of anaesthesia and to make a comparison with former surveys from Germany and other countries. Questionnaires on the practice of pain relief, especially epidural analgesia, during labour and delivery were sent to 1178 anaesthetic departments in Germany in the second half of 1996. Five hundred and thirty-two completed replies were received, which represent 46.9% of all German obstetric units. The majority of the departments of anaesthesia practising epidural analgesia have an epidural rate of less than 10% and 10.2% of the departments do not offer this method to their parturients. In 86.8% of all units performing epidural analgesia, the epidural catheter is placed by an anaesthetist. Only 6.5% of the units provide a 24-h epidural service which is exclusively assigned to labour and delivery. In 77.8% of the units, this service is not exclusively assigned to obstetrics, but also to other duties. Of the obstetric units offering epidural analgesia, 14.7% have no epidural service at night. Plain local anaesthetics for epidural analgesia are used by 55.9% of the departments, a combination of local anaesthetics with epidural opioids by 28.7%. Epidural analgesia is predominantly (82.2%) maintained by intermittent bolus administration. Although the rate of epidural analgesia increased during recent decades, this method is not offered to all parturients. Further improvements in the use of epidural analgesia for labour seem to be necessary.

Current practice of epidural analgesia during normal labour

A postal survey of all maternity units in the United Kingdom was conducted to gain information regarding policies for epidural analgesia for labour. The average epidural rate was 19.7% and 78% of units offered a 24-h service. The majority of units inserted the epidural with the patient in the lateral position, using a midline approach, with loss of resistance to air and saline being used almost equally. Most units used 3 ml of 0.5% bupivacaine as a test dose, and only 10% of units used adrenaline in the test dose. The use of adrenaline in subsequent top-ups was infrequent. Bupivacaine 0.5% was used most frequently for the initial and the second stage top-up, whereas 0.25% was most often used during the first stage of labour. Midwife top-ups were allowed in 75% of units and in only 14% of cases was this from a local anaesthetic reservoir. Epidural analgesia using a continuous infusion of anaesthetic was routinely used in 28% of units, mostly with 0.125% bupivacaine; about half of these units did so because midwives were unable to perform top-ups. Routine use of epidural opioids was most frequent when anaesthetic infusions were used, otherwise it was uncommon.

Survey of the Practice of Epidural Analgesia in a Regional Sample of Obstetric Units

Summary An investigation into practices of the epidural services in a regional sample of obstetric units was undertaken following recent reported disasters associated with epidural analgesia for labour pain. A questionnaire was completed by all 22 obstetric units in the region, which included six teaching, 14 district and two independent centres. In three units the epidural service was shared with the obstetricians. A continuous anaesthetic presence was provided in 16 of 22 units. There was considerable variation in the attendance upon epidural patients by the anaesthetists. Instructions to midwives for top-ups and subsequent care of patients followed no uniform pattern. Midwife in-service training in the initial management of serious epidural complications and in cardiopulmonary resuscitation was inconsistent. In some units, the avoidance of aortocaval compression was not emphasised in the management of serious complications such as severe maternal hypotension, total spinal blockade or cardiac arrest of the parturient. The results obtained in this survey suggest that there is a need to review the requirements in the provision of obstetric epidural services and consideration should be given to the establishment of a generally accepted standard of practice.

Survey of the practice of epidural analgesia in a regional sample of obstetric units.

An investigation into practices of the epidural services in a regional sample of obstetric units was undertaken following recent reported disasters associated with epidural analgesia for labour pain. A questionnaire was completed by all 22 obstetric units in the region, which included six teaching, 14 district and two independent centres. In three units the epidural service was shared with the obstetricians. A continuous anaesthetic presence was provided in 16 of 22 units. There was considerable variation in the attendance upon epidural patients by the anaesthetists. Instructions to midwives for top-ups and subsequent care of patients followed no uniform pattern. Midwife in-service training in the initial management of serious epidural complications and in cardiopulmonary resuscitation was inconsistent. In some units, the avoidance of aortocaval compression was not emphasised in the management of serious complications such as severe maternal hypotension, total spinal blockade or cardiac arrest of the parturient. The results obtained in this survey suggest that there is a need to review the requirements in the provision of obstetric epidural services and consideration should be given to the establishment of a generally accepted standard of practice.