Predictive model for the inadequate labor epidural analgesia: An outcome of the prospective observational study at university women's hospital

Rudram Muppuri, Deepak Gupta, Shvetank Agarwal, Vitaly Soskin

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Continuous epidural analgesic infusions provide superior analgesia as compared to other forms of labor analgesia. However, inadequate analgesia after labor epidurals is not uncommon and has been found to be as high as 24% in some studies. The mechanism of these failures include inappropriate epidural catheter location, tissue compartmentalization within epidural space, delayed migration, kinking, occlusion or disconnection of correctly placed epidural catheter. Aims: The aim of our study was to examine the effect of various factors on the incidence of inadequate pain relief with labor epidurals. Methods: Eighteen independent potential risk factors for failed epidurals were collected from each parturient: patient characteristics (body mass index, history of failed epidural, opioid tolerance, illicit drug use and back abnormalities), labor details (parity, singleton versus multiples pregnancies, induced versus spontaneous labor, augmentation with oxytocin, malpresentation and cervical dilatation greater than 7 cm), epidural technique (experience of the operator-resident/specialist, method of loss of resistance-air/saline, paresthesia during epidural insertion, difficult insertion, ultrasound used, and number of attempts) and other factors (time of epidural insertion). Results: Data collected from 502 parturients showed that difficulty in placement of epidural catheter was reported in 43 (8.6%) patients. Inadequate pain relief was seen in 104 (21%) parturients. Cervical dilatation >7 cm, previous failed epidural analgesia, paresthesia during epidural insertion, and loss of resistance using air were found to be the best predictors of inadequate epidural analgesia A constructed classification table showed that the predictive model correctly classified 96.7% of successful epidurals of producing adequate pain relief. However, the predictive model correctly classified only eighteen failed/inadequate epidurals (16.8%) as failures. Overall, 79.7% of the epidurals placed were successfully classified by the predictive model. Conclusion: In parturients identified as being at high risk for failed epidural, ultrasound guidance, saline-based loss of resistance technique, and appropriate intra-epidural-space length of catheter are the methods that should be utilized to lower the incidence of failure.

Original languageEnglish (US)
Pages (from-to)719-724
Number of pages6
JournalMiddle East Journal of Anesthesiology
Volume21
Issue number5
StatePublished - Jun 1 2012
Externally publishedYes

Fingerprint

Epidural Analgesia
Observational Studies
Catheters
Parturition
Prospective Studies
Analgesia
First Labor Stage
Epidural Space
Paresthesia
Pain
Air
Multiple Pregnancy
Incidence
Street Drugs
Oxytocin
Parity
Opioid Analgesics
Analgesics
Body Mass Index

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Predictive model for the inadequate labor epidural analgesia : An outcome of the prospective observational study at university women's hospital. / Muppuri, Rudram; Gupta, Deepak; Agarwal, Shvetank; Soskin, Vitaly.

In: Middle East Journal of Anesthesiology, Vol. 21, No. 5, 01.06.2012, p. 719-724.

Research output: Contribution to journalArticle

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