Labour epidural analgesia audit in a teaching hospital in a developing country

Background: Neuraxial analgesia is currently considered to be the most effective method of intrapartum analgesia, causing little maternal and foetal sedation. While epidural analgesia has been well studied in developed countries, it is uncertain whether or not the results, particularly regarding complication rates, can be extrapolated to the South African public hospital context.Method: The available records for indications, complications and patient satisfaction of parturients receiving labour epidural analgesia at Tygerberg Hospital from 1 January to 31 December 2012 were reviewed in a retrospective one-year audit.Results: During the audited period, 157 (2.2%) of 7 005 parturients managed for labour and delivery at our hospital received epidural analgesia. One hundred and forty-nine records could be retrieved for analysis. Epidural analgesia was only used for medical indications and not patient demand. 73.2% of indications were cardiovascular disease and morbid obesity. Excluding a 13.4% incidence of hypotension, a 15.4% incidence of early complications [the majority (91.3%) being minor in nature] was observed. One (0.7%) potentially fatal incident of accidental systemic local anaesthetic administration and toxicity with cardiac arrest occurred. Parturients reported being “happy” or “very happy” (50% and 36%, respectively) with the epidural analgesia.Conclusion: Only 2.2% of parturients received labour epidural analgesia at a tertiary “developing world” hospital, primarily because of personnel constraints. Indications were predominantly cardiovascular disease and morbid obesity. Analgesia on demand was not provided. However, the incidence of complications from labour epidural analgesia was in keeping with that observed in developed countries. Most women were “happy” with their labour epidural analgesia.