|| Checking for direct PDF access through Ovid
Regional anesthetic techniques are in widespread use and have low rates of maternal morbidity and mortality. This retrospective study examined the safety of the routine use of epidural anesthesia by an experienced anesthetic team in a select group of obstetric and gynecologic patients.An anesthesia and obstetric database at the authors' institution was surveyed and contained the records of 43,784 patients who had an intervention under various types of anesthesia between 1993 and 2006. Hospital records of 35,628 patients were reviewed in detail; the study group included 34,109 patients who received an epidural block. The 5 authors performed all of the anesthetic procedures during the study period and meticulously recorded all of the complications in the database. Major complications were accidental dural puncture, total spinal block, high epidural block, cardiac arrest, neurologic complications (seizures, motor weakness, neurogenic bladder, and intracranial hemorrhage), epidural hematoma, and infection. Patients were visited by the anesthesia team within the first 24 hours after the procedure and follow-up by the obstetric department usually occurred at 42 hours postprocedure. Success rate, major complication rates, and mortality rates were the end points studied. Minor complications (hypotension, nausea/vomiting, headache, and backache) were not considered in the analysis.Of the 35,628 cases, 8386 women had vaginal deliveries, 21,130 had cesarean deliveries, and 6112 women had various gynecologic procedures. In 96% of the cases, epidural anesthesia was performed successfully; the rate of epidural anesthesia increased from 57% to 96% over the 14-year period. The most common major complication was inadvertent dural puncture, which occurred in 45 patients (incidence of 13/10,000). One patient with total spinal blockade and 3 with high epidural anesthesia required supplemental general anesthesia. Transient neurologic dysfunction occurred in 7 patients. In 1 patient, intracranial hemorrhage developed day 3 after cesarean delivery; she had an intracerebral aneurysm rupture, which was clipped, and a hematoma was evacuated. She was discharged on day 7 without problems. No cardiac arrests, epidural hematomas, epidural infections, or deaths were associated with epidural anesthesia.Limitations of this retrospective study include a long study period, so the variables in patient condition (ie, preeclampsia) and obstetric or gynecologic techniques (ie, patient positioning) that could have affected the outcomes recorded could not be ascertained. However, the success rate with the high number of epidural blocks, the increase in number over the study interval, the low complication and morbidity rates, and the absence of patient deaths indicate that epidural anesthesia/analgesia is a reliable and safe procedure in this practice setting.