Epidural anesthesia performed during labor by obstetricians: outcome analysis

Objective: The objective of this outcome analysis was to determine the frequency, effectiveness, and complications of epidural anesthesia performed during labor by attending obstetricians at Minden Medical Center from January 1993 through December 1995.Methods: Each of the 1,851 obstetrical patient charts for the 3-year time period was reviewed and data were obtained from the 1,565 charts of the patients who received epidural anesthesia in labor.Results: During the 3-year period studied 1,851 patients had obstetrical delivery at Minden Medical Center. There were 147 planned cesareans and 1,704 patients who experienced labor. Among the patients who experienced labor 1,565 (91.8%) received epidural anesthesia performed by their attending obstetrician. Epidural anesthesia was effective for adequate pain relief in 1,484 patients (94.8%). Hypotension requiring ephedrine occurred in 24 patients (1.5%). Subarachnoid puncture requiring a blood patch for treatment of postural headache occurred in 4 patients (0.26%) and inadvertent spinal anesthesia occurred in 3 patients (0.2%). All of the inadvertent spinals were recognized with the test dose of 5 mL of 1.5% lidocaine and no high or total spinals resulted. A high level of anesthesia, above T5 dermatome, occurred in 16 patients (1.0%). No seizures, neurological sequelae, toxicity to the anesthesia agent, anaphylaxis, or deaths occurred. There were no cases of urinary retention secondary to an epidural anesthetic requiring patient use of a retention catheter on discharge from the hospital.Conclusion: Outcome analysis of patients who received epidural anesthesia performed during labor by obstetricians at Minden Medical Center indicated obstetricians at this hospital provided epidural anesthesia for a high percentage (91.8%) of laboring patients effectively (94.8% had adequate pain relief), and with no serious complications.