The relationship between resited epidural catheters after secondary epidural catheter failure and vaginal delivery: A retrospective case‐control study

• Published in: Acta anaesthesiologica Scandinavica Vol. 65; no. 3; pp. 397 - 403
• Main Authors: Orbach‐Zinger, Sharon, Eidelman, Leonid. A., A.Wazwaz, Susan, Ben‐Haroush, Avi, Fireman, Shlomo, Heesen, Michael, Hadar, Eran, Weiniger, Carolyn F, Kornilov, Evgeniya
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-03-2021
• Subjects: Analgesia; Catheters; Childbirth & labor; Epidural; Failure; Gestation; Labor; Labor Epidural Analgesia; Medical instruments; Operative Delivery; Oxytocin; Pain perception; Vagina; Labor Epidural Analgesia; Failure; Operative Delivery
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.13734

Background
There are cases where epidural analgesia is initially effective but subsequently fails and needs to be resited. We evaluated the rate of normal vaginal delivery and operative delivery among parturients who had resited epidurals compared to parturients with epidurals that were not resited.
Methods
A retrospective electronic medical review of parturients with a singleton gestation attempting normal vaginal delivery under epidural analgesia between the years 2012‐2016 was conducted. Resited epidurals were defined as epidurals that were considered effective but subsequently removed and reinserted. For each resited epidural, two previous and two consecutive deliveries of parturients with normally functioning epidural catheter inserted by the same anesthesiologist were matched controls (non‐resited epidurals).
Results
There were 35,984 attempted vaginal deliveries with 118 resited epidurals and 472 non‐resited epidurals. When adjusted for nulliparity, oxytocin administration, sex and weight of the baby, and maternal BMI, labor epidural catheter replacement was not associated with need for instrumental or caesarean delivery, (OR 1.5, 95% CI 0.91‐2.49, P = .11).
Conclusions
Need for labor epidural catheter replacement does not appear to be associated with need for operative delivery based on this single‐centre cohort analysis.