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SUCCESS OF LABOUR EPIDURAL EXTENSION FOR CAESAREAN SECTION BEFORE AND AFTER PROTOCOLISED USE OF LIDOCAINE – A RETROSPECTIVE AUDIT
Author(s): ,
Gladstone, G.*
Affiliations:
Bedford Hospital, Department of Anaesthesia, Bedford, United Kingdom
,
Bates, B.
Affiliations:
Bedford Hospital, Department of Anaesthesia, Bedford, United Kingdom
,
Hammerbeck, H.
Affiliations:
Bedford Hospital, Department of Anaesthesia, Bedford, United Kingdom
Rashid, A.
Affiliations:
Bedford Hospital, Department of Anaesthesia, Bedford, United Kingdom
ESRA Academy. Hammerbeck H. Sep 13, 2017; 190819; 327 Topic: Obstetric Population
Dr. Henry Hammerbeck
Dr. Henry Hammerbeck

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Abstract
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Background and Aims:

If a parturient has a functioning labour epidural and requires emergency Caesarean Section (CS) the epidural should be extended to provide surgical anaesthesia without delay1. A systematic review2 published in British Journal of Anaesthesia in 2011 found that lidocaine based mixtures demonstrated superior speed in extending epidural labour analgesia for CS. In January 2013, we standardised our epidural top-up mix to 2% lidocaine 18mls with 1/1000 adrenaline 0.1mls and 8.4% sodium bicarbonate 2mls (LAB) and wished to assess if there was a corresponding reduction in conversion to general anaesthesia (GA) in patients with pre-existing epidurals requiring CS.

Methods:

After local audit department approval, we retrieved data from our obstetric anaesthesia database for the 2 years (01/01/2011- 31/12/2012) before and after (01/01/2014-31/12/2016) the change in protocol.

Results:



Despite the superior speed of onset, the major concern was that the time taken to freshly prepare the LAB mix would negate the advantages of rapid onset. We introduced a ‘top-up box’, with printed instructions on the top in which all the necessary syringes and ampoules were kept, to reduce the preparation time.

Conclusions:

Introduction of protocolised LAB top-up mix appears to have reduced the conversion rate to GA in women with labour epidurals posted for LSCS.

References

1. Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. BJOG 2011;118 (Suppl. 1):1–203

2. Hillyard, S.G. et Al. Extending epidural analgesia for emergency Caesarean section: a meta-analysis. Br J Anaesth (2011) 107 (5): 668-678.

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