Advertisement

Epidural catheter replacement rates with dural puncture epidural labor analgesia compared with epidural analgesia without dural puncture: a retrospective cohort study

  • A.A. Berger
    Correspondence
    Correspondence to: A.A. Berger, Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, 330 Brookline Ave., Boston, MA 02215, USA.
    Affiliations
    Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • J. Jordan
    Affiliations
    Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • Y. Li
    Affiliations
    Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    † Co-principal Investigators.
    J.J. Kowalczyk
    Footnotes
    † Co-principal Investigators.
    Affiliations
    Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    † Co-principal Investigators.
    P.E. Hess
    Footnotes
    † Co-principal Investigators.
    Affiliations
    Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    † Co-principal Investigators.
Published:August 02, 2022DOI:https://doi.org/10.1016/j.ijoa.2022.103590

      Highlights

      • Up to 13% of labor epidural catheters fail and require replacement.
      • Retrospective study of 19 123 labor neuraxial analgesia procedures.
      • Dural puncture epidural (DPE) was compared with lumbar epidural analgesia (LEA).
      • DPE was associated with fewer failures than LEA.
      • DPE catheters failed significantly later than those placed for LEA.

      Abstract

      Background

      Lumbar epidural analgesia (LEA) is commonly used for labor analgesia but up to 13% of epidural catheters fail and require replacement. Combined spinal-epidural analgesia is associated with a lower catheter failure rate. Few data exist regarding catheter replacement rates after dural-puncture epidural (DPE). We conducted a retrospective analysis comparing catheter failure rates between epidural and DPE techniques.

      Methods

      This retrospective single-center trial reviewed all labor neuraxial analgesia procedures among 18 726 women across five years, and identified 810 DPE and 2667 LEA procedures. Catheter failure rates, consisting of replacement or requirement of general anesthesia for cesarean delivery, were compared. Propensity score matching was used to balance the groups.

      Results

      Dural-puncture epidural was associated with significantly fewer catheter failures compared with LEA (74/759 vs. 49/759, odds ratio 0.64, 95% CI 0.44 to 0.93, P=0.02). Sensitivity analysis excluding cases of general anesthesia confirmed this relationship. Risk factors identified for catheter failure included age, body mass index, and nulliparity. Dural-puncture epidural was associated with a longer mean time to catheter replacement (918 min vs. 609 min, P=0.04). Kaplan-Meier and Cox multivariate analyses confirmed this relationship. There was no significant difference in the requirement for epidural analgesia supplementation, but DPE required supplementation significantly later than LEA. There was no difference in the rate of headache or epidural blood patch between groups.

      Conclusions

      Dural-puncture epidural is associated with fewer catheter failures and replacements than LEA, without an increase in the rate of post-dural puncture headache or epidural blood patch.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wong C.A.
        Epidural and spinal analgesia: anesthesia for labor and vaginal delivery.
        in: Chestnut D.H. Wong C.A. Tsen L.C. Chestnut’s obstetric. Anesthesia principles and practice. Elsevier, Philadelphia, PA2019: 474-539
        • Niesen A.D.
        • Jacob A.K.
        Combined spinal-epidural versus epidural analgesia for labor and delivery.
        Clin Perinatol. 2013; 40: 373-384https://doi.org/10.1016/j.clp.2013.05.010
        • Simmons S.W.
        • Taghizadeh N.
        • Dennis A.T.
        • Hughes D.
        • Cyna A.M.
        Combined spinal-epidural versus epidural analgesia in labour.
        Cochrane Database Syst Rev. 2012; 2012https://doi.org/10.1002/14651858.CD003401.pub3
        • Layera S.
        • Bravo D.
        • Aliste J.
        • Tran D.Q.
        A systematic review of dural puncture epidural analgesia for labor.
        J Clin Anesth. 2019; 53: 5-10https://doi.org/10.1016/j.jclinane.2018.09.030
        • Eappen S.
        • Blinn A.
        • Segal S.
        Incidence of epidural catheter replacement in parturients: a retrospective chart review.
        Int J Obstet Anesth. 1998; 7: 220-225https://doi.org/10.1016/S0959-289X(98)80042-3
        • Pan P.H.
        • Bogard T.D.
        • Owen M.D.
        Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries.
        Int J Obstet Anesth. 2004; 13: 227-233https://doi.org/10.1016/j.ijoa.2004.04.008
        • Booth J.M.
        • Pan J.C.
        • Ross V.H.
        • et al.
        Combined spinal epidural technique for labor analgesia does not delay recognition of epidural catheter failures.
        Anesthesiology. 2016; 125: 516-524https://doi.org/10.1097/ALN.0000000000001222
        • Bauer M.E.
        • Kountanis J.A.
        • Tsen L.C.
        • Greenfield M.L.
        • Mhyre J.M.
        Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials.
        Int J Obstet Anesth. 2012; 21: 294-309https://doi.org/10.1016/j.ijoa.2012.05.007
        • Groden J.
        • Gonzalez-Fiol A.
        • Aaronson J.
        • Sachs A.
        • Smiley R.
        Catheter failure rates and time course with epidural versus combined spinal-epidural analgesia in labor.
        Int J Obstet Anesth. 2016; 26: 4-7https://doi.org/10.1016/j.ijoa.2016.01.004
        • Nageotte M.P.
        • Larson D.
        • Rumney P.J.
        • Sidhu M.
        • Hollenbach K.
        Epidural analgesia compared with combined spinal–epidural analgesia during labor in nulliparous women.
        N Engl J Med. 1997; 337: 1715-1719https://doi.org/10.1056/nejm199712113372402
        • Heesen M.
        • Rijs K.
        • Rossaint R.
        • Klimek M.
        Dural puncture epidural versus conventional epidural block for labor analgesia: a systematic review of randomized controlled trials.
        Int J Obstet Anesth. 2019; 40: 24-31https://doi.org/10.1016/j.ijoa.2019.05.007
        • Vandenbroucke J.P.
        • von Elm E.
        • Altman D.G.
        • et al.
        Strengthening the reporting of observational studies in epidemiology (strobe): explanation and elaboration.
        PLoS Med. 2007; 4: e297https://doi.org/10.1371/journal.pmed.0040297
        • Vasudevan A.
        • Snowman C.E.
        • Sundar S.
        • Sarge T.W.
        • Hess P.E.
        Intrathecal morphine reduces breakthrough pain during labour epidural analgesia.
        Br J Anaesth. 2007; 98: 241-245https://doi.org/10.1093/bja/ael346
        • Hess P.E.
        • Pratt S.D.
        • Lucas T.P.
        • et al.
        Predictors of breakthrough pain during labor epidural analgesia.
        Anesth Analg. 2001; 93: 414-418https://doi.org/10.1213/00000539-200108000-00036
        • Wilson S.H.
        • Wolf B.J.
        • Bingham K.
        • et al.
        Labor analgesia onset with dural puncture epidural versus traditional epidural using a 26-gauge Whitacre needle and 0.125% bupivacaine bolus: a randomized clinical trial.
        Anesth Analg. 2018; 126: 545-551https://doi.org/10.1213/ANE.0000000000002129
        • Chau A.
        • Bibbo C.
        • Huang C.-C.
        • et al.
        Dural puncture epidural technique improves labor analgesia quality with fewer side effects compared with epidural and combined spinal epidural techniques.
        Anesth Analg. 2017; 124: 560-569https://doi.org/10.1213/ANE.0000000000001798
        • Patel R.
        • Urits I.
        • Orhurhu V.
        • et al.
        A comprehensive update on the treatment and management of postdural puncture headache.
        Curr Pain Headache Rep. 2020; 24: 24https://doi.org/10.1007/s11916-020-00860-0
        • Costa A.C.
        • Satalich J.R.
        • Al-Bizri E.
        • et al.
        A ten-year retrospective study of post-dural puncture headache in 32,655 obstetric patients.
        Can J Anesth. 2019; 66: 1464-1471https://doi.org/10.1007/s12630-019-01486-6
        • Hasoon J.
        Radiographic evidence of an epidural and paraspinal abscess after lumbar epidural steroid injection.
        Glob J Anesth Pain Med. 2020; 2: 188-190
        • Hasoon J.
        • Berger A.
        • Urits I.
        • Orhurhu V.
        Greater occipital nerve blocks for the treatment of postdural puncture headache after labor epidural.
        Saudi J Anaesth. 2020; 14: 262https://doi.org/10.4103/sja.SJA_632_19
        • Van De Velde M.
        • Teunkens A.
        • Hanssens M.
        • Van Assche F.A.
        • Vandermeersch E.
        Post dural puncture headache following combined spinal epidural or epidural anaesthesia in obstetric patients.
        Anaesth Intensive Care. 2001; 29: 595-599https://doi.org/10.1177/0310057X0102900605
        • Makito K.
        • Matsui H.
        • Fushimi K.
        • Yasunaga H.
        Incidences and risk factors for post–dural puncture headache after neuraxial anaesthesia: a national inpatient database study in Japan.
        Anaesth Intensive Care. 2020; 48: 381-388https://doi.org/10.1177/0310057X20949555