Labour epidural analgesia audit in a tertiary state hospital in South Africa

Abstract

Background: Neuraxial analgesia is currently considered the most effective method of labour analgesia. While well studied in developed countries, it is uncertain whether the results, particularly regarding epidural analgesia complication rates, can be extrapolated to the context of the South African public hospital.
Method: A retrospective one-year audit reviewed available records for indications for-, complications of-, and patient satisfaction with labour epidural analgesia at Tygerberg Hospital, Western Cape.
Results: During the period audited, 157 (2.2%) of 7 005 parturients received labour epidural analgesia. One hundred and forty nine records were retrieved for analysis. Epidural analgesia was not provided on patient request. Rather, specific indications for epidural analgesia in 73.2% of these cases were preeclampsia, cardiovascular disease and morbid obesity. The incidence of complications was 32.3%, comprising hypotension (13.4%) and all other complications (18.9%). Most complications were minor and self-limiting (97.9%). One serious adverse event (cardiac arrest) due to accidental intravenous infusion of bupivacaine was recorded. Resuscitation with lipid emulsion was successful. Parturients reported being “happy” or “very happy” (50% and 36% respectively) with epidural analgesia.
Conclusions: At this tertiary referral hospital in the Western Cape, only 2.2% of parturients received labour epidural analgesia, possibly because of personnel time constraints. Indications comprised predominantly preeclampsia, cardiovascular disease and morbid obesity. The incidence of complications from labour epidural analgesia was in line with that observed in developed countries. Most patients were happy with their analgesia. This audit identifies an urgent need for improvement of the labour epidural service at this institution.

Keywords: analgesia, complications, epidural, labour indications