Neuraxial anesthesia for postpartum tubal ligation at an academic medical center

Carlos Delgado, Wil Van Cleve, Christopher Kent, Emily Dinges, Laurent A Bollag, Carlos Delgado, Wil Van Cleve, Christopher Kent, Emily Dinges, Laurent A Bollag

Abstract

Background: Use of an in situ epidural catheter has been suggested to be efficient to provide anesthesia for postpartum tubal ligation (PPTL). Reported epidural reactivation success rates vary from 74% to 92%. Predictors for reactivation failure include poor patient satisfaction with labor analgesia, increased delivery-to-reactivation time and the need for top-ups during labor. Some have suggested that this high failure rate precludes leaving the catheter in situ after delivery for subsequent reactivation attempts. In this study, we sought to evaluate the success rate of neuraxial techniques for PPTL and to determine if predictors of failure can be identified. Methods: After obtaining IRB approval, a retrospective chart review of patients undergoing PPTL after vaginal delivery from July 2010 to July 2016 was conducted using CPT codes, yielding 93 records for analysis. Demographic, obstetric and anesthetic data (labor analgesia administration, length of epidural catheter in epidural space, top-up requirements, time of catheter reactivation, final anesthetic technique and corresponding doses for spinal and epidural anesthesia) were obtained. Results: A total of 70 patients received labor neuraxial analgesia. Reactivation was attempted in 33 with a success rate of 66.7%. Patient height, epidural volume of local anesthetic and administered fentanyl dose were lower in the group that failed reactivation. Overall, spinal anesthesia was performed in 60 patients, with a success rate of 80%. Conclusions: Our observed rate of successful postpartum epidural reactivation for tubal ligation was lower than the range reported in the literature. Our success rates for both spinal anesthesia and epidural reactivation for PPTL were lower than the generally accepted rates of successful epidural and spinal anesthesia for cesarean delivery. This gap may reflect a lower level of motivation on behalf of both the patients and anesthesia providers to tolerate "imperfect" neuraxial anesthesia once fetal considerations are removed.

Keywords: epidural anesthesia; general anesthesia; obstetrical anesthesia; postpartum period; spinal anesthesia; tubal sterilization.

Conflict of interest statement

No competing interests were disclosed.

Figures

Figure 1.. Distribution of final anesthetic technique…
Figure 1.. Distribution of final anesthetic technique for postpartum tubal ligation in relation to success of the initial technique.

References

    1. Committee on Health Care for Underserved Women: Committee opinion no. 530: access to postpartum sterilization. Obstet Gynecol. 2012;120(1):212–5. 10.1097/AOG.0b013e318262e354
    1. Goodman EJ, Dumas SD: The rate of successful reactivation of labor epidural catheters for postpartum tubal ligation surgery. Reg Anesth Pain Med. 1998;23(3):258–61. 10.1016/S1098-7339(98)90051-7
    1. Vincent RD, Jr, Reid RW: Epidural anesthesia for postpartum tubal ligation using epidural catheters placed during labor. J Clin Anesth. 1993;5(4):289–91. 10.1016/0952-8180(93)90120-4
    1. Viscomi CM, Rathmell JP: Labor epidural catheter reactivation or spinal anesthesia for delayed postpartum tubal ligation: a cost comparison. J Clin Anesth. 1995;7(5):380–3. 10.1016/0952-8180(95)00050-R
    1. Powell MF, Wellons DD, Tran SF, et al. : Risk factors for failed reactivation of a labor epidural for postpartum tubal ligation: a prospective, observational study. J Clin Anesth. 2016;35:221–4. 10.1016/j.jclinane.2016.08.004
    1. McKenzie C, Akdagli S, Abir G, et al. : Postpartum tubal ligation: A retrospective review of anesthetic management at a single institution and a practice survey of academic institutions. J Clin Anesth. 2017;43:39–46. 10.1016/j.jclinane.2017.09.006
    1. Richardson MG, Hall SJ, Zuckerwise LC: Postpartum Tubal Sterilization: Making the Case for Urgency. Anesth Analg. 2018;126(4):1225–31. 10.1213/ANE.0000000000002174
    1. Thurman AR, Janecek T: One-year follow-up of women with unfulfilled postpartum sterilization requests. Obstet Gynecol. 2010;116(5):1071–7. 10.1097/AOG.0b013e3181f73eaa
    1. Curatolo M, Orlando A, Zbinden AM, et al. : A multifactorial analysis to explain inadequate surgical analgesia after extradural block. Br J Anaesth. 1995;75(3):274–81. 10.1093/bja/75.3.274
    1. Hogan Q: Distribution of solution in the epidural space: examination by cryomicrotome section. Reg Anesth Pain Med. 2002;27(2):150–6. 10.1053/rapm.2002.29748
    1. Huffnagle SL, Norris MC, Huffnagle HJ, et al. : Intrathecal hyperbaric bupivacaine dose response in postpartum tubal ligation patients. Reg Anesth Pain Med. 2002;27(3):284–8. 10.1053/rapm.2002.31210
    1. Habib AS, Muir HA, White WD, et al. : Intrathecal morphine for analgesia after postpartum bilateral tubal ligation. Anesth Analg. 2005;100(1):239–43. 10.1213/01.ANE.0000143955.37182.09
    1. Teoh WH, Ithnin F, Sia AT: Comparison of an equal-dose spinal anesthetic for cesarean section and for post partum tubal ligation. Int J Obstet Anesth. 2008;17(3):228–32. 10.1016/j.ijoa.2007.10.006
    1. Pan PH, Bogard TD, Owen MD: Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth. 2004;13(4):227–33. 10.1016/j.ijoa.2004.04.008
    1. Kinsella SM: A prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia. 2008;63(8):822–32. 10.1111/j.1365-2044.2008.05499.x
    1. Russell IF: Technique of anaesthesia for caesarean section. Raising the Standards: A Compendium of Audit Recipes. 2006;166–7.
    1. Einhorn LM, Habib AS: Evaluation of failed and high blocks associated with spinal anesthesia for Cesarean delivery following inadequate labour epidural: a retrospective cohort study. Can J Anaesth. 2016;63(10):1170–8. 10.1007/s12630-016-0701-3
    1. Abouleish EI: Postpartum tubal ligation requires more bupivacaine for spinal anesthesia than does cesarean section. Anesth Analg. 1986;65(8):897–900.
    1. Huffnagle SL, Norris MC, Leighton BL, et al. : Do patient variables influence the subarachnoid spread of hyperbaric lidocaine in the postpartum patient? Reg Anesth. 1994;19(5):330–4.
    1. Adesope OA, Einhorn LM, Olufolabi AJ, et al. : The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery. Int J Obstet Anesth. 2016;26:8–14. 10.1016/j.ijoa.2016.01.007
    1. Guglielmo L, Pignataro A, Di Fiore G, et al. : Conversion of spinal anesthesia into general anesthesia: an evaluation of more than 35,000 spinal anesthetics. Minerva Anestesiol. 2010;76(9):714–9.
    1. Traynor AJ, Aragon M, Ghosh D, et al. : Obstetric Anesthesia Workforce Survey: A 30-Year Update. Anesth Analg. 2016;122(6):1939–46. 10.1213/ANE.0000000000001204
    1. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124(2):270–300. 10.1097/ALN.0000000000000935
    1. Huber AW, Mueller MD, Ghezzi F, et al. : Tubal sterilization: complications of laparoscopy and minilaparotomy. Eur J Obstet Gynecol Reprod Biol. 2007;134(1):105–9. 10.1016/j.ejogrb.2006.06.016
    1. Delgado C, Van Cleve W, Kent C, et al. : Dataset 1 in: Neuraxial anesthesia for postpartum tubal ligation at an academic medical center. F1000Research. 2018. 10.5256/f1000research.16025.d218466
    1. Albanese A, French M, Gossett DR: Request and fulfillment of postpartum tubal ligation in patients after high-risk pregnancy. Contraception.2017;95(3) : 10.1016/j.contraception.2016.08.009 234-238 10.1016/j.contraception.2016.08.009

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