Labour epidural efficacy

Published Date: 19th July 2016

Publication Authors: Yoxall PF

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The aim of our audit was to establish the efficacy of our labour epidurals by assessing the height of the block we achieved whist the epidural was in use and the requirements for ‘top up’ boluses. Following the initial audit we introduced a standardised loading dose to prevent disconnection from the epidural pump, therefore improving safety, and re-audited to see if this had any change to our epidural efficacy.

Methods

We performed the audit during February and then March 2013 by reviewing the notes of all women who had received labour epidurals. We noted the initial loading dose of local anaesthetic given, then the initial block height plus the highest and lowest blocks recorded. Finally we noted the number of top up boluses required. During February the anaesthetist was free to give any loading dose they chose, from March we standardised practice by asking everyone to give 10 ml solution via the pump to reduce need for disconnection. Following the initial loading doses all epidurals were run with a continuous infusion of 0.1% levobupivacaine + 2 mcg/ml fentanyl. The internal audit standards which we used were that 100% of women should have an initial sensory block level between T10 and T5.

Results

Fifty seven women received a labour epidural in February and seventy nine in March following standardisation of practice. (See Table).

Discussion

During the audit period, despite not achieving the targeted 100% standard, the majority of labour epidurals objectively provided a good sensory block level. Importantly for our department, we noted that introducing a standardised loading dose regime did not appear to reduce the quality of labour epidural analgesia and was associated with a 19% reduction in top up bolus requirements. The purpose of introducing a standardised loading dose via the pump was to promote a culture of reducing disconnections of the epidural solution delivery system. Although rare, abscess formation complicates around 0.2–3.7 per 100 000 obstetric epidurals [1] and the consequences may be devastating. Frequent disconnections may result in hub colonisation [2] which could be a source for introduction of infection. Our audit results have supported a change which may help to improve the safety of our labour epidurals.

Wrigley, H; Yoxall, P. (2014).  An audit to assess labour epidural efficacy . Anaesthesia. 69 (Suppl 4), 79.

 

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