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PRACTICE PATTERNS IN OBSTETRICAL/REGIONAL ANESTHESIA

Discipline of Anesthesia, St. Clare's Hospital. St. John's, Newfoundland, Canada A1C 5B8

INTRODUCTION

Our main objective was to determine if it is common practice to dose local anesthetics directly through the epidural needle. This has not been previously examined in the literature, although the technique is described by several authors^1,2.

METHODS

A national survey of all CAS members in 1999. A total of 1928 surveys (21 questions) related to various aspects of obstetric/ regional anesthesia were mailed April 99. Non responders received a second mailing. Data was analyzed using students t-test and chi-square test.

RESULTS

A total of 1202 surveys were received for a response rate of 62.3%. The mean years of active clinical practice was 14.8±9.5. Obstetric anesthesia was practiced by 926 (78.2% n = 1184) respondents. Epidurals were performed by 1138(97% n = 1173) anesthesiologists. A total of 295 (26.1% n = 1129) anesthesiologists give their main local anesthetic dose through the needle to establish a neuraxial block for some portion of their epidurals. The range in frequency of use of this technique is shown in the graph below. Anesthesiologists who employed this technique had significantly more years of active practice (17.2 vs 13.4 p=0.000). Only 13.3% (p<0.02) of GP anesthetists used this technique which was significantly lower than other groups. When a procedure is expected to last less then 1 hour, 75% of those surveyed always placed an epidural catheter when using an epidural technique. When polled on the safety of this method (n=1088) the group was split. Dosing local anesthetic through the needle was deemed safe by 40.3% and unsafe by 43.7%. Sixteen percent of responders were unsure of the safety. Those who felt the technique was safe had significantly more years of active practice (15.5 vs 13.3 p = 0.000).

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This is the first study to show that administering the main local anesthetic dose through the epidural needle is a relatively common technique. Anesthesiologists seem to be split evenly in their clinical impression of its safety. Future studies should be designed to examine the issue of efficiency, efficacy, and safety of this technique.

REFERENCES

1 Epidural Analgesia. 1978 p 201.

2 Neural Blockade. 1998 p 297.

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Edington, R. Articles by Pridham, J. Search for Related Content PubMed Articles by Edington, R. Articles by Pridham, J.