A Five-Year Prospective Analysis of the Efficacy, Safety and Morbidity of Epidural Anaesthesia Performed by a General Practitioner Anaesthetist in an Isolated Rural Hospital

Abstract

During ajive-year period, 324 epidurals were performed by a general practitioner anaesthetist in an isolated rural hospital. Of these 160 were for obstetric purposes, 72% in primagravida patients, the majority in early and established labour (median cervical dilatation of 3.0 cm). The median epidural insertion time was seven minutes: 80% were free of all complications, there were no dural taps and there was a failure rate of 2%. The median visual analogue pain score (VAPS) was 8.3 prior to insertion and at peak of epidural blockade it was reduced to 0.5. Ten per cent of patients had unblocked segments, half of these were corrected and 90% of patients had even blocks. Despite higher pain scores in the 6-10 cm cervical dilatation group, epidural analgesia was just as effective when compared to the 0.5 cm group. Seventy-seven percent of women interviewed the day after delivery were fully satisjied with the epidural: 19% said it was considerable help, 2% some help and 2% said no help at all. During epidural caesarean section (n = 72), 75% of patients were comfortable, 17% had some discomfort and 7% required general or spinal anaesthesia. The incidence of hypotension (systolic blood pressure < 90 mmHg), was 24.6% with a median ephedrine dose of 10 mg; however, with a greater than 20% drop in systolic blood pressure, the dose of ephedrine required to maintain blood pressure increased in a log-dose fashion. For women who received epidurals in labour, the caesarean section rate was 25%, instrumental vaginal delivery 34% and spontaneous vaginal delivery 41 %. There were no adverse neonatal outcomes.

Registration of a Statistical Shape Model of the Lumbar Spine to 3D Ultrasound Images

“…In back pain management, accessing the lumbar epidural space presents major difficulties. The success rate of proper needle insertion is a dismal 60% after 10 attempts [3] when no guidance is used, clearly an inadequate practice. Contemporary radiological needle guidance with CT and fluoroscopy requires specialized facilities often unavailable to patients living in rural areas, and involve X-ray radiation.…”

Biomechanically Constrained Groupwise Statistical Shape Model to Ultrasound Registration of the Lumbar Spine

“…Facet joint injections, a common percutaneous spinal injection procedure used for pain management, requires a high level of physician experience to effectively deliever the anesthetic dose to the target area. The success rate of proper needle insertion is a dismal 60% after 10 attempts[75] when no guidance is used, clearly an inadequate practice. Contemporary radiological needle guidance with CT and fluoroscopy requires specialized facilities often unavailable to patients living in rural areas, and involve X-ray radiation.…”

Instrumentation for Epidural Anesthesia

“…More rare are the inadvertent dural puncture, fetal distress, neurologic injury, cardiac arrest, allergic shock and maternal death. Although the use of conventional epidurals has increased over a few decades, it continues to have a failure rate in the range of 6-25% [1,2]. One study shows a success rate of 60% after 10 attempts and 84% after 60 attempts [3].…”