Identificación de factores predictores de técnica epidural dificultosa en la paciente obstétrica

Abstract

Introduction: Repeated attempts punctureare risk factors for the appearance of neurologic complications caused by the practice of spinal analgesia and increase patient anxiety. The purpose of this study is to determine which factor sare better predictors of difficult epidural catheter placement in the obstetric patient.Material and methods: Prospective observational study in 120 pregnant women at term who request edepidural analgesia during labor. Demographic variables and history of difficult or unsuccessful spinal anesthesia were collected. Anatomical variables were identified and the quality of anatomical landmarks was classified according to criteria published by Chien in four grades. The conditions of the technique and the experience of anesthesiologists were similar in all cases. It was considered as difficult puncture that in which was made more than one attempt on skin or more than one change of direction with the epidural needle in interspinous space.We collected the successand complications of the technique.Results: 36.67 % of cases were classified as difficult punctures according to the criteria of the study. In most cases the technique was effective obtaining asuccessful analgesia. The incidence of repeat epidural puncture was 5 %. In patients classified in grade 4, the percentage of difficult epidural puncture was 90 %, requiring in 80 % of the cases 3 or more attempts. In patients with a history of difficult neuraxial technique in 28.57 % of the cases was found difficulty in epidural puncture. Body habitus had no significant effect on the rate success in first attempt. Discussion:Our study represents a good estimationof a difficult neuraxial blockade. It would bedifficult to know if there flected datawould be applicable to the lateral decubitus technique where anatomical landmarksare more difficult to identify.Conclusions: Our study concludes thatt he most reliable method to predict the possibility of a technical difficulty in the placement of lumbar epidural catheter, is the examination of the back of the patient to identify the quality of anatomical landmarks and identify obvious deformities of the spine.