naa a22 4500 510744192 CHVBK 20180411083039.0 cr unu---uuuuu 180411e20130801xx s 000 0 eng 10.1007/s12630-013-9976-9 doi (NATIONALLICENCE)springer-10.1007/s12630-013-9976-9 Quality of labour neuraxial analgesia and maternal satisfaction at a tertiary care teaching hospital: a prospective observational study [Elektronische Daten] [Jefferson Clivatti, Naveed Siddiqui, Akash Goel, Melissa Shaw, Ioana Crisan, Jose Carvalho] Qualité de l'analgésie neuraxiale pour le travail obstétrical et satisfaction maternelle dans un hôpital universitaire de soins tertiaires: une étude observationnelle prospective Purpose: Current labour analgesia practices are evidence-based; however, such evidence often originates in controlled trials, the results of which may not be readily applicable in the context of day-to-day clinical practice. The objective of this study was to evaluate the effectiveness of and maternal satisfaction with the neuraxial labour analgesia regimen provided at a tertiary care teaching hospital. Methods: All women with a viable pregnancy who requested neuraxial analgesia for labour during November 2011 at our institution were approached to participate in this prospective study. Patients were managed as per departmental routine based on a patient-controlled epidural analgesia regimen with a maintenance solution of 0.0625% bupivacaine and fentanyl 2μg·mL−1. Demographic and obstetric data, characteristics of the neuraxial analgesia, pain scores, side effects, and complications were recorded. After delivery, patients completed a satisfaction questionnaire. Results: All 332 eligible women were approached, and 294 completed the study. Most women received epidural analgesia and considered its placement comfortable. A large number of women reported having experienced pain during the first or second stages of labour (38% and 26%, respectively). Although 24.4% of women required top-ups both by nurses and physicians, adjustment in the local anesthetic maintenance concentration was made in only 7.8% of the cases. Most women (92%) were satisfied with the quality of analgesia. Unintentional dural puncture occurred in three (1%) cases, and there were no cases of intravascular catheter insertion or systemic local anesthetic toxicity. Overweight women (body mass index 25-30kg·m−2) (adjusted odds ratio [AOR]=2.56; 95% confidence interval [CI]: 1.1 to 5.97), those undergoing induced labour (AOR=2.4; 95% CI: 1.2 to 5.2), and those requiring top-ups by the anesthesiologist (AOR=5.08; 95% CI: 2.31 to 11.11) were associated with more dissatisfaction with pain control during the first stage of labour. Conclusion: Although our technique with dilute local anesthetic-opioid infusion was considered effective in previous randomized clinical trials, it did not provide sufficient labour analgesia for a large proportion of women. Nevertheless, most women were satisfied with their pain management and childbirth experience. Strategies to individualize care for labour and delivery should be readily available while providing labour analgesia. Canadian Anesthesiologists' Society, 2013 Clivatti Jefferson Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut Siddiqui Naveed Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut Goel Akash Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut Shaw Melissa Department of Nursing, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Crisan Ioana Department of Nursing, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut Carvalho Jose Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/8(2013-08-01), 787-795 0832-610X 60:8<787 2013 60 12630 https://doi.org/10.1007/s12630-013-9976-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9976-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Clivatti Jefferson Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Siddiqui Naveed Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Goel Akash Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Shaw Melissa Department of Nursing, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Crisan Ioana Department of Nursing, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Carvalho Jose Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Room 781, M5G 1X5, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/8(2013-08-01), 787-795 0832-610X 60:8<787 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer