A twenty-year retrospective analysis of the efficacy of epidural analgesia-anesthesia when administered and/or managed by obstetricians.

Abstract

The purpose of this study was to retrospectively determine the safety and efficacy of epidural anesthesia when administered by obstetricians in a community hospital. Data containing 14,598 epidural procedures from 31,818 births were obtained from delivery room logs over a period of 20 years, from 1972 through 1991. Data were displayed graphically to view trends over time. Odds ratios were calculated to determine the associations of epidural anesthesia with oxytocin stimulation, episiotomy, assisted vaginal delivery (forceps or vacuum extraction), and cesarean section. Particular scrutiny was given to any listed complication during labor or delivery. Over the 20-year period epidural anesthesia was administered without serious complication by various obstetricians with different training. Technique improved as procedures became standardized, resulting in an increase in the number of epidural procedures over the 20-year period. Incidence was also increased among women requiring oxytocin augmentation, episiotomies, and assisted vaginal deliveries. Of the total number performed, < 5% of patients required additional anesthesia. Over a 20-year period epidural analgesia or anesthesia has been an effective and safe procedure when performed and supervised by obstetricians-gynecologists in a community hospital.