Success rate and outcome of labor epidural among variable levels of residents and practicing anesthesiologists in an academic medical center in Saudi Arabia

Abstract

Background and Aims: This study aimed to highlight differences in success rates and patient outcomes during epidural insertion among anesthesia staff, junior trainees, and staff anesthesiologists. Methods: We included all women who received a labor epidural between January 1, 2020 and April 30, 2022. The cases were divided into three groups: junior residents, senior residents, and staff anesthesiologists. Results: Among 822 cases included in analysis, 92, 240, and 490 catheters were placed by junior residents, senior residents, and staff anesthesiologists, respectively. Although the success rate among junior residents (90.7%) was lower than those of senior residents (97%) and staff anesthesiologists (95.1%), the difference was not significant (P = 0.067). The mean procedural time in minutes was significantly longer in the junior resident’s group (18.1 min) compared to the senior residents (14.18 min) and staff anesthesiologists (14.87 min) (P < 0.001). A significant difference was observed in the number of needle pricks and catheter insertion attempts when comparing the junior residents, senior residents, and staff anesthesiologists’ groups (P < 0.001). In the logistic regression analysis, procedural time remained the only predictor of epidural success. Conclusions: With the success rate above 90%, junior anesthesia trainees require more time and attempts to insert labor epidurals. It is essential that training programs provide opportunities for anesthesia trainees to become proficient in their epidural insertion techniques prior to clinical practice.

Keywords

• analgesia
• clinical skills
• experiential learning
• learning curve
• medical education
• obstetric anesthesia