Pain during caesarean delivery in a tertiary maternity hospital: a retrospective cohort study (2022-2023).
Caesarean delivery
Epidural anaesthesia
Failed neuraxial anaesthesia
Intra-operative pain
Obstetric anaesthesia
Pregnancy
Spinal anaesthesia
Journal
International journal of obstetric anesthesia
ISSN: 1532-3374
Titre abrégé: Int J Obstet Anesth
Pays: Netherlands
ID NLM: 9200430
Informations de publication
Date de publication:
18 Jul 2024
18 Jul 2024
Historique:
received:
28
05
2024
revised:
14
07
2024
accepted:
14
07
2024
medline:
2
9
2024
pubmed:
2
9
2024
entrez:
1
9
2024
Statut:
aheadofprint
Résumé
Intra-operative pain during Caesarean delivery (PDCD) is the leading cause of successful litigation against obstetric anaesthesiologists. PDCD may require conversion to general anaesthesia (GA). The aim of this analysis is to assess our incidence of PDCD and associated GA conversion. Data were collected from electronic patient records. Data included baseline demographics, incidence of PDCD and rates of GA conversion, proportion of PDCD cases attributable to failed epidural (EA) or spinal anaesthesia (SA), and level of sensory and motor blockade in cases of PDCD. Results were audited against current standards set by the Royal College of Anaesthetists 'rates of PDCD should be <5% for category 4, <15% for categories 2-3, and <20 % for category 1 CD ' and that 'rates of conversion to GA due to neuraxial complications should be <1% for category 4, <5% for categories 2-3 and <15% for category 1 patients'. During the 12-month study period, 2,429 patients underwent CD, of whom 52 (2.1%) experienced PDCD. The incidence of PDCD was 3.1% (41/1,309) for category 1-3 patients, while 1% (11/1,120) of category 4 patients experienced PDS. Of the 52 patients with PDCD, 17 patients required GA (33%). SA was used in 24/52 (47%) cases and EA in 28/52 (53%) cases. The median level of sensory block in patients with PDCD was located at the T4 dermatome, the median level of motor block was Bromage level 2. PDCD occurred in 2.1% of CD, one-third required conversion to GA. Most patients experiencing PDCD met current motor and sensory blockade criteria.
Sections du résumé
BACKGROUND
BACKGROUND
Intra-operative pain during Caesarean delivery (PDCD) is the leading cause of successful litigation against obstetric anaesthesiologists. PDCD may require conversion to general anaesthesia (GA). The aim of this analysis is to assess our incidence of PDCD and associated GA conversion.
METHODS
METHODS
Data were collected from electronic patient records. Data included baseline demographics, incidence of PDCD and rates of GA conversion, proportion of PDCD cases attributable to failed epidural (EA) or spinal anaesthesia (SA), and level of sensory and motor blockade in cases of PDCD. Results were audited against current standards set by the Royal College of Anaesthetists 'rates of PDCD should be <5% for category 4, <15% for categories 2-3, and <20 % for category 1 CD ' and that 'rates of conversion to GA due to neuraxial complications should be <1% for category 4, <5% for categories 2-3 and <15% for category 1 patients'.
RESULTS
RESULTS
During the 12-month study period, 2,429 patients underwent CD, of whom 52 (2.1%) experienced PDCD. The incidence of PDCD was 3.1% (41/1,309) for category 1-3 patients, while 1% (11/1,120) of category 4 patients experienced PDS. Of the 52 patients with PDCD, 17 patients required GA (33%). SA was used in 24/52 (47%) cases and EA in 28/52 (53%) cases. The median level of sensory block in patients with PDCD was located at the T4 dermatome, the median level of motor block was Bromage level 2.
CONCLUSIONS
CONCLUSIONS
PDCD occurred in 2.1% of CD, one-third required conversion to GA. Most patients experiencing PDCD met current motor and sensory blockade criteria.
Identifiants
pubmed: 39217683
pii: S0959-289X(24)00247-4
doi: 10.1016/j.ijoa.2024.104235
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
104235Informations de copyright
Copyright © 2024 Elsevier Ltd. All rights reserved.