Failure rate of labor epidural: An observational study among different levels of trainee anesthesiologists in a university hospital of a developing country

Abstract

Context: Frequent use of labor epidural has also led to a corresponding increase in failed epidural analgesia (FEA). Aims: This study aims to identify the overall rate of FEA and evaluate its association with trainee anesthesiologist at different years/levels of anesthesia residency training. Settings and Design: Prospective observational study was conducted for one year in the labor room suit of a university hospital. Methods and Material: After university ethics committee approval, full-term parturient receiving labor epidurals and consenting for the study were included. FEA was identified by the presence of one or more set criteria of failure including; pain of numeric rating scale of >4 at 45 minutes after epidural placement, accidental dural puncture, need to re-site the epidural, abandoning the procedure, and maternal dissatisfaction with labor pain relief. Statistical Analysis Used: A binary logistic regression was used to assess the association between failure rate of labor epidural and grades of anesthesiologists. Odds ratio (OR) and 95% confidence interval (CI) were reported. P value ≤0.05 was considered significant. Results: Out of 500 women included, 76 (15.2%) had FEA, which was significantly hiagh in 2nd and 3rd year residents compared to 5th year and above level anesthesiologists [OR = 2.08; 95% CI: 1.17 to 3.67; P = 0.012]. Failure rate was also high but insignificant in 4th year residents compared to senior level anesthesiologists [OR = 1.78; 95%CI: 0.89 to 3.53; P = 0.098]. Conclusions: The incidence of FEA is comparable to those quoted in literature from developed countries and shows association to experience and year of training of anesthesia residents.

Keywords

• failure rate
• labor epidural
• anesthesia training
• trainee resident