- Major variations are seen in the practice of initiating and sustaining labour epidural analgesia (LEA), which is the most effective method of pain relief during labour. An electronic poll was undertaken in various obstetric anaesthesia fellowship programs in the U.S.A, the aim was to analyse and evaluate the best technique.
- Depending on the healthcare institution, common anesthetic approaches had the potential to vary between continuous epidural infusion (CEI), combined spinal epidural (CSE), epidural (EPI) with or without dural puncture, patient-controlled epidural bolus (PCEA), and programmable intermittent epidural bolus (PIEB).
- Furthermore, healthcare institutions differed in LEA medication administration, such as the volume and concentration of local anesthetics (e.g. bupivacaine, ropivacaine) and use of opioids (e.g. fentanyl, sufentanil).
- CEI alone is less reliable technique, but it has demonstrated considerable benefits when paired with PCEA. PIEB combined with PCEA was reported to result in higher maternal satisfaction, fewer instrumental births, and less adverse outcomes.
- Even though this evaluation survey included limitations, such as sample size and the timing of subsequent boluses, the results revealed areas of agreement and disagreement. Future evaluation is recommended for approach and drug use to achieve greater satisfaction and better outcomes.
Summary of "A survey of labour epidural practices at obstetric anesthesia fellowship programs in the United States"
Summary published October 12, 2022