AB217. SOH21AS048. Patient reported efficacy of epidural analgesia in labour in University Hospital Galway (UHG)

Background: Epidural analgesia (EA) is the gold standard for labour analgesia. The literature suggests a higher failure rate with EA among maternity patients compared with general surgical patients. This audit evaluates the quality of analgesia among maternity patients in UHG.

Methods: Data were collected from 105 women who received epidurals in labour in UHG between the 25/08/2020 and 16/11/2020. The women quantified their pain score 45 minutes after insertion of the epidural. Patient satisfaction was also recorded at a follow up visit the next day. Successful analgesia was defined as a 45-minute pain score ≤3, no evidence of accidental dural puncture (ADP) or re-siting and a post satisfaction rating of satisfied/very satisfied. These were then compared against the Royal College of Anaesthetist (RCOA) standard of best practice.

Results: Seventy nine percent of (N=85) women fulfilled the criteria for successful analgesia (RCOA >/=85%). Eighty-one percent (N=86) were either satisfied/very satisfied at the follow up visit (RCOA >/=98%). There was a strong correlation between pain score at 45 minutes and patient satisfaction at follow up. Eighty percent (N=85) had a pain score of 3 or less after 45 minutes (RCOA >/=88%), while 3% (N=4) recorded a pain score of 10 at 45 minutes. Two percent (N=2) (RCOA <15%) required resitting and there was no evidence of dural puncture (RCOA <1%).

Conclusions: The results of this audit failed to meet the standards of best practice proposed by the Royal College of Anaesthetists. Reasons should be explored. Studies suggest that the following factors could be contributory; the use of low concentration local anaesthetic, unrealistic patient expectations, high BMI, cervical dilatation >7 cm and operator inexperience/inadequate training.

Keywords: Epidural; analgesia; pain; obstetrics; anaesthesia