Obstetric regional analgesia in the Jesenice General hospital in year 2006
Background: The aim of this retrospective analysis of the obstetric regional analgesia (ORA) in Jesenice General Hospital in year 2006 was to evaluate our work and present results. We analysed workload, quality of the analgesia and patients’ satisfaction. We also estimated the OR for vacuum extraction (VE) in nulliparous labouring women having ORA. We compared quality of analgesia and total local analgesic consumption in nulliparous women having VE or spontaneous delivery.
Methods: We performed retrospective analysis of labours with ORA in year 2006. All women received epiduraly mixture of 0.1 % bupivacaine with 2 µg of fentanyl per ml in intermittent boluses.The labour pain was assessed using visual analogue scale (VAS). We used median and interquartile range to describe distribution of these values and mean with standard deviation to describe distribution of other data (local anaesthetic consumption). We considered patient with pain VAS 3 or less adequately treated, VAS 4 and 5 sufficiently and VAS 6 and more insufficiently treated. We used odds ratio as measurement of risk for VE, t-test for differences in local anaesthetic consumption and Mann-Whitney test to evaluate differences in pain between tested groups.
Results: 225 labouring women opted for ORA or 38 % of all labouring women in year 2006. We performed 224 ORA, 59 % during regular work, 41 % during turn of duty. 18 % of ORA were performed between 10 p.m. and 7.00 a.m. In 98 % of cases epidural analgesia was used. Anaesthesiologic work took 16 minutes in average (SD 6.06). Analgesia was started at VAS median 5 (IQR 4–6.5) and at average cervical dilatation 4.1 cm (SD 1.4). Average consumption of bupivacaine was 55 mg (SD 23.7) and fentanyl 91.7 µg (SD 46.5). Most common complications were inadequate analgesia, and misplacement of epidural catheter (10/222), dural tap (6/222), and unilateral analgesia (2/222). 70 labours were ended with VE (13 %; n = 532). There were 27 (8.7 %; n = 309) VE in labours without ORA, and 42 VE in labours with epidural analgesia. OR for VE in labouring women with epidural analgesia was 2.62 (CI 2.43–2.80). Nulliparous women with ORA having VE had equally good analgesia but needed more local anaesthetic (p < 0.05). There was no difference in pain between nulliparous women with induced or spontaneous start of labour. Median pain during labour was estimated 4 (IQR 2–5). 15 % of patients had inadequately treated pain and 13 % of patients were only partially satisfied, unsatisfied or disappointed. 84 % of women estimated pain as equal or less than expected, 87 % were satisfied or very satisfied. 96 % of women would have ORA again.
Conclusions: ORA is invasive method of labour pain relief that can be safely and effectively performed in small hospital. Trust and cooperation among all members of staff in delivery room is essential. Each obstetric ward should find balance between adequate analgesia and unwanted side effects of ORA. The method is not to be compromised by maternal dissatisfaction or excessive analgesia with obstetric side effects.
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