Key result
Obstetrician-placed epidurals show similar complication rates to anaesthetists but link to more general anaesthesia conversions.
Why the study?
It was unclear whether obstetricians and anaesthetists differed in expertise and outcomes when providing epidural analgesia on the labour ward.
Does epidural insertion by obstetricians compared to anaesthetists affect the incidence of complications or failed analgesia in obstetric patients?
Observational
No
Does epidural insertion by obstetricians compared to anaesthetists affect the incidence of complications or failed analgesia in obstetric patients?
Obstetricians can be trained to help provide a 24-hour epidural service with similar complication rates to anaesthetists, though with a higher rate of conversion to general anaesthesia for operative procedures.
Answers are grounded in this paper and cite their sources.
May support obstetrician training for 24-hour epidural services; leaves open whether higher GA conversion reflects technique or selection.
A retrospective study was undertaken of all epidurals inserted on the labour ward in BMH Rinteln from 1980 to 1985 inclusive, during which time both obstetricians and anaesthetists participated in providing an epidural service. It was impossible to show any difference between the expertise of anaesthetists and obstetricians in siting epidurals, when the incidence of complications or failed analgesia was compared. However, epidurals inserted by obstetricians were more likely to be converted to general anaesthetics for operative procedures than those inserted by anaesthetists, although no adequate explanation for this could be found. Given increasing patient demand for a 24-hour epidural service, and the logistic difficulties in Service hospitals of providing sufficient anaesthetic staff for this, obstetricians can be trained to help provide such a service.
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W A McFadzean (1990) conducted an observational in Obstetric epidural anaesthesia. Epidurals inserted by obstetricians vs. Epidurals inserted by anaesthetists was evaluated on Incidence of complications or failed analgesia. Epidurals inserted by obstetricians had similar rates of complications and failed analgesia compared to anaesthetists, but were more likely to be converted to general anaesthesia.
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