Izvorni znanstveni članak
https://doi.org/10.20471/acc.2022.61.s2.05
Ten-Year Follow-up of Quality in Regional Anesthesia and Analgesia in Obstetrics
Ivona Brkić Gudelj
; Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Sveti Duh Zagreb, Croatia
Ivan Šklebar
; Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Sveti Duh Zagreb, Croatia; Catholic University of Croatia, School of Medicine, Zagreb, Croatia; Bjelovar University of Applied Sciences, Croatia
Dubravko Habek
; Department of Gynecology and Obstetrics, University Hospital Sveti Duh Zagreb, Croatia; Catholic University of Croatia, School of Medicine, Zagreb, Croatia
Sažetak
Introduction: Quality assessment of provided healthcare is becoming a standard
in numerous health institutions worldwide, which is beneficial for both the patient and the institution.
In order to achieve this standard, it is necessary to develop quality indicators in all segments of healthcare.
Postdural puncture headache is a common complication following neuraxial blocks, especially in
obstetric anesthesia. If severe, it is a cause of emotional and psychological distress and must be treated
by a blood patch.
Aim: The aim of this study was to determine whether the number of these complications is reduced
when blood patch frequency is monitored and analyzed and to assess the effect of countermeasures
in order to improve the quality and safety of regional anesthesia in obstetrics.
Methods: Before 2009 and during that year at the University Hospital Sveti Duh, there had been
a large number of severe postdural puncture headaches after spinal anesthesia and epidural analgesia
treated by a blood patch in 6.12% of cases. After noticing the rising number of blood patches,
we decided to analyses data every year. We recorded all blood patches injected to obstetric patients
within the period of nine year, from 2009 to 2018 and concurrently we introduced a set of measures
to improve the quality of neuraxial blocks, such as the use of atraumatic 26 or 27-gauge pencil-point
spinal needles and modern neuraxial blockade protocols. Data were collected from anesthesiology and
gynecology protocols and analyzed with MedCalc software, version 18.1.2.
Results: The frequency of blood patch applications has been reduced from 6.12% to 0.30%, which
is statistically significant. The percentage of placed epidural catheters for vaginal birth increased from
21% in 2009 to 38% in 2018. Although not statistically significant, the number of pregnant women
undergoing a caesarean section is also growing, while the total number of births is falling. The proportion
of cesarean sections in spinal anesthesia varies from year to year.
Discussion: A statistically significant decrease in the number of installed blood patches clearly indicates
the positive effect of measures taken to improve quality, which could contribute to the growing
interest of pregnant women in childbirth in epidural analgesia. The number of placed epidural catheters
is increasing despite the decline in the total number of deliveries and the increase in the number
of deliveries completed by cesarean section.
Conclusion: Monitoring the incidence of severe post-puncture headaches treated with blood
patches has shown great progress in improving the quality and safety of regional anesthesia and analgesia
in our institution, so we believe that monitoring the number of blood patches could serve as an
indicator of regional anesthesia and analgesia in obstetrics. Monitoring the number of blood patches
shows that the frequency of post-puncture headaches does not correlate only with the type of needle
or epidural catheter used for neuroaxial blocks, but is also a sensitive indicator of any deviations from
the achieved standards. Furthermore, it indicates the need for careful analysis of causes in order to
adopt and implement appropriate countermeasures.
Ključne riječi
Blood patch; Postdural puncture headache; Quality indicators; Regional anesthesia and analgesia; Obstetric anesthesia
Hrčak ID:
284299
URI
Datum izdavanja:
1.9.2022.
Posjeta: 662 *