The Association Between Labour Epidural Case Volume and the Rate of Accidental Dural Puncture

N. S. Sidhu,A. Cavadino,H. Ku,P. Kerckhoffs,M. Lowe

Anaesthesia（2022）SCI 1区

Cited 4|Views5

Abstract

SummaryAccidental dural puncture is a recognised complication of labour epidural placement and can cause a debilitating headache. We examined the association between labour epidural case volume and accidental dural puncture rate in specialist anaesthetists and anaesthesia trainees. We performed a retrospective cohort study of labour epidural and combined spinal‐epidural nerve blocks performed between 1 July 2013 and 31 December 2017 at Waitemata District Health Board, Auckland, New Zealand. The mean (SD) annual number of obstetric epidural and combined spinal‐epidural procedures for high‐case volume specialists was 44.2 (15.0), and for low‐case volume specialists was 10.0 (6.8), after accounting for caesarean section combined spinal‐epidural procedures. Analysis of 7976 labour epidural and combined spinal‐epidural procedure records revealed a total of 92 accidental dural punctures (1.2%). The accidental dural puncture rate (95%CI) in high‐case volume specialists was 0.6% (0.4–0.9%) and in low‐case volume specialists 2.4% (1.4–3.9%), indicating probable skill decay. The odds of accidental dural puncture were 3.77 times higher for low‐ compared with high‐case volume specialists (95%CI 1.72–8.28, p = 0.001). Amongst trainees, novices had a significantly higher accidental dural puncture complication rate (3.1%) compared with registrars (1.2%), OR (95%CI) 0.39 (0.18–0.84), p = 0.016, or fellows (1.1%), 0.35 (0.16–0.76), p = 0.008. Accidental dural puncture complication rates decreased once trainees progressed past the ‘novice’ training stage.

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Key words

clinical competence,epidural analgesia,complications,patient safety,post dural puncture headache,quality measures,patient care

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