Obstetrical epidural anaesthesia in a Canadian outpost hospital

The number of parturients receiving epidural anaesthesia in university medical centres is increasing. This trend is not paralleled in rural hospitals. Obstetrical epidural anaesthesia as provided in a 40-bed, remote hospital is reviewed for the ten-year period from January 1974 to December 1983. Charts were reviewed retrospectively for 116 patients undergoing epidural blockade. The indications, complication rates, as well as infant outcomes were noted. Seven per cent of all parturients received epidural anaesthetics. Ninety per cent of this group received systemic sedation or narcotics prior to epidural catheter insertion. Nineteen patients (16.3 per cent) experienced a major complication, including four dural punctures (3.4 per cent), ten episodes of significant hypotension (8.6 per cent), blood vessel puncture during catheter insertion in four patients (3.4 per cent), and transient paresthesia in one patient (0.8 per cent). Considerations for the provision of epidural anaesthesia in a remote hospital are discussed.