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Neuraxial Anesthesia during the COVID-19 Pandemic: Report from a Large Academic Medical Center
Olutoyosi T Ogunkua1, Emily H Adhikari2, Irina Gasanova1
1Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.
American Journal of Perinatology
|January 5, 2023
Summary
During the COVID-19 pandemic, dural puncture epidural (DPE) use increased in SARS-CoV-2-positive patients for labor pain management. However, overall neuraxial techniques and complication rates remained unchanged.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Infectious Diseases
Background:
- Labor pain is managed with neuraxial techniques like epidural, dural puncture epidural (DPE), and combined spinal-epidural (CSE).
- The COVID-19 pandemic raised concerns about procedures involving dural puncture, potentially influencing neuraxial technique selection.
Purpose of the Study:
- To investigate changes in neuraxial analgesia techniques for labor pain management before and after the COVID-19 pandemic onset.
- To determine if DPE usage increased in patients with concerns for COVID-19, hypothesizing its utility in confirming neuraxial placement.
Main Methods:
- A retrospective cohort study compared neuraxial techniques in 10,971 laboring patients (5,528 in 2019, 5,443 in 2020) at a single center.
- Statistical analyses included Chi-square, Kruskal-Wallis, and Cochran-Mantel-Haenszel tests to compare technique frequencies and complication rates between groups and time periods.
- Patients were analyzed based on SARS-CoV-2 status.
Main Results:
- Epidural analgesia remained the most common technique in both 2019 and 2020.
- No significant differences were observed in overall neuraxial technique frequency or rates of accidental dural puncture and postdural puncture headache between 2019 and 2020.
- DPE usage significantly increased in SARS-CoV-2-positive patients compared to SARS-CoV-2-negative patients in 2020, without a corresponding rise in complications.
Conclusions:
- The increased use of DPE in SARS-CoV-2-positive patients is likely due to its ability to confirm epidural placement via a small spinal needle.
- Neuraxial analgesia techniques for labor pain and associated complication rates (accidental dural puncture, postdural puncture headache) were not significantly affected by the COVID-19 pandemic overall.
- DPE offers a valuable advantage in confirming placement, particularly in specific patient populations during public health crises.
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