Volume 15, Issue 3 , Pages 217-222, July 2006
A survey of labor patient-controlled epidural anesthesia practice in California hospitals☆☆☆
Abstract
Background
Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for labor analgesia including fewer physician interventions, improved analgesia and satisfaction, and reduced local anesthetic doses. However, anesthesiologists have been slow to adopt this technique, first described in 1988. No previous studies have evaluated specific labor patient-controlled epidural analgesia practices in the United States. The aim of this study was to determine labor epidural and patient-controlled epidural analgesia practices among California hospitals.
Methods
Following institutional review board exemption approval, an online survey was created using freeonlinesurveys.com®. An anonymous survey was sent via e-mail to 230 California Society of Anesthesiologists’ members chosen at random to represent their hospitals’ labor analgesia practices.
Results
We received 133 replies from the 230 survey requests sent, a 58% response rate. The median labor epidural rate among the hospitals involved was 65% (range 0-95%). Overall, only 25% of California hospitals use patient-controlled epidural analgesia for analgesia in labor, with greater use among hospitals with dedicated obstetric anesthesia coverage and larger numbers of deliveries. Reasons given for not using patient-controlled epidural analgesia include cost, clinician preference, safety concerns and the inconvenience of change.
Conclusions
Despite the potential advantages of patient-controlled epidural analgesia over continuous epidural infusions for labor analgesia, patient-controlled epidural analgesia has not been widely adopted in California hospitals. Education regarding this technique is needed to encourage its increased use.
Keywords: Patient-controlled epidural analgesia, Labor
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☆ The study was conducted at Lucile Packard Children’s Hospital and Stanford University School of Medicine, Stanford, California. This study was funding internally by the Department of Anesthesia, Stanford University School of Medicine. The authors involved in this study and the preparation of the manuscript received no external funding.
☆ Findings from this study were presented in part at the Society for Obstetric Anesthesia and Perinatology (SOAP), 37th Annual Meeting in Palm Springs, May 2005.
☆ A copy of the online survey is available on request from the corresponding author.
PII: S0959-289X(06)00048-3
doi:10.1016/j.ijoa.2006.03.006
© 2006 Elsevier Ltd. All rights reserved.
Volume 15, Issue 3 , Pages 217-222, July 2006
