Table 3.
Details of labour epidural analgesia.
| Characteristics | Inadvertent dural puncture or PDPH (n = 94) | No inadvertent dural puncture or PDPH (n = 26,301) | Unadjusted OR (95%CI) | P - value |
|---|---|---|---|---|
| Number of anaesthesiologists performing the procedure | 1.0 ± 0.2 | 1.0 ± 0.1 | 3.52 (1.22–10.17) | 0.020 |
| Seniority of anaesthetist | 0.012a | |||
| Registrar | 43 (45.7%) | 11,305 (43.0%) | Reference | – |
| Consultant | 11 (11.7%) | 5,860 (22.3%) | 0.49 (0.25–0.96) | 0.037 |
| Fellow | 1 (1.1%) | 27 (0.1%) | 9.74 (1.30–73.30) | 0.027 |
| Medical Officer | 39 (41.5%) | 9,098 (34.6%) | 1.12 (0.73–1.74) | 0.590 |
| Neuraxial technique | ||||
| Combined spinal-epidural | 85 (90.4%) | 25,341 (96.3%) | Reference | – |
| Standard epidural | 9 (9.6%) | 960 (3.7%) | 2.80 (1.40–5.57) | 0.004 |
| Loss-of-resistance technique | ||||
| Saline | 92 (97.9%) | 26,136 (99.4%) | Reference | – |
| Air | 2 (2.1%) | 165 (0.6%) | 3.45 (0.84–14.10) | 0.085 |
| Standard PCEA regimenb | 65 (69.1%) | 23,032 (87.6%) | 0.32 (0.21–0.49) | <0.001 |
| No PCEA or non-standard PCEA regimens usedb | 24 (25.5%) | 2,363 (9.0%) | 3.47 (2.18–5.53) | <0.001 |
| Number of procedure attemptsc | 1.8 ± 1.0 | 1.2 ± 0.7 | 1.48 (1.32–1.66) | <0.001 |
| Procedure duration (minute) | 14.1 ± 13.3 | 10.2 ± 6.8 | 1.05 (1.03–1.06) | <0.001 |
| Depth of epidural space (cm) | 5.4 ± 1.1 | 4.8 ± 1.1 | 1.10 (1.05–1.16) | <0.001 |
| Concentration of ropivacaine (per 0.1%) | 0.1 ± 0.0 | 0.1 ± 0.0 | 0.07 (0.01–0.33) | 0.001 |
| Pre-procedure pain scored | 5.7 ± 3.5 | 5.6 ± 3.5 | 1.00 (0.90–1.40) | 0.976 |
| Post-procedure Bromage scoree | 0.1 ± 0.5 | 0.0 ± 0.1 | 7.31 (4.13–12.93) | <0.001 |
| Post-procedure pain scored | 0.4 ± 1.2 | 0.3 ± 1.0 | 1.11 (0.95–1.30) | 0.183 |
| Post-procedure sensory levelf | <0.001a | |||
| T7/T8/T9/T10 | 47 (50%) | 17,126 (65.1%) | Reference | – |
| T1/T2/T3 | 4 (4.3%) | 206 (0.8%) | 7.06 (2.53–19.82) | <0.001 |
| T4/T5/T6 | 37 (39.4%) | 8,040 (30.6%) | 1.67 (1.09–2.58) | 0.019 |
| T11/T12/L1/L2 | 6 (6.4%) | 927 (3.5%) | 2.36 (1.01–5.53) | 0.049 |
| Breakthrough paing | 1.1 ± 1.4 | 0.2 ± 0.5 | 5.44 (3.63–8.16) | <0.001 |
| Pain score at time of breakthrough paind | 2.7 ± 3.5 | 1.6 ± 2.6 | 1.14 (1.07–1.21) | <0.001 |
| Satisfaction scoreh | 81.1 ± 12.4 | 89.9 ± 9.4 | 0.95 (0.94–0.96) | <0.001 |
Values are mean ± SD or number (proportion).
CI, confidence interval. OR, odds ratio. PCEA, patient-controlled epidural analgesia. PDPH, post-dural puncture headache. SD, standard deviation.
Type 3 p-value.
Standard PCEA is defined as infusion of 0.1%–0.125% ropivacaine with 2 μg.ml−1 fentanyl at 8–12 ml h−1, parturient-triggered bolus of 5 ml, and lockout period of 10 min.
Number of procedure attempts defined as the number of skin punctures by the Tuohy needle.
11-point numerical rating scale. 0: no pain to 10: worst pain imaginable.
Modified Bromage score. 0: able to flex hip, 1: able to flex knee but not hip, 2: able to flex ankle only, 3: unable to flex ankle, recorded by trained midwives.
Defined as the dermatomal level at which the parturient reported the same cold sensation to ice compared to the shoulder.
Breakthrough pain is defined as parturient complaints of pain or pressure requiring unscheduled supplemental epidural medication after the establishment of epidural labour analgesia.
Satisfaction score. 0: very dissatisfied to 100: very satisfied.