Incidence and risk factors for epidural re-siting in parturients with breakthrough pain during labour epidural analgesia: a cohort study.

INTRODUCTION: Epidural re-siting is one of the significant events during labour epidural analgesia that may result in decreased patient satisfaction. The aim of our study was to investigate the incidence of and factors associated with epidural re-siting in parturients using epidural analgesia, with an emphasis on those with breakthrough pain. METHODS: A retrospective cohort study of 10170 parturients who received labour epidural analgesia. The primary outcome was the incidence of epidural re-siting (binary data). Univariate and multivariate logistic regression analysis were performed to find associated risk factors for re-siting. RESULTS: Less than 1% (0.85%, 86/10170) of the women in the study had their epidural re-sited. Amongst the subset of women with breakthrough pain, the incidence of epidural re-siting was higher (4.7%, 68/1454). Most of the women who had their epidural re-sited had experienced breakthrough pain (79%, 68/86). Amongst all parturients, the presence of breakthrough pain (OR=21.31), hypotension (OR=4.18) and venous puncture (OR=2.74) were significantly associated with re-siting. Amongst the parturients with breakthrough pain who required epidural re-siting, lower cervical dilatation (OR=0.81), higher number of episodes of breakthrough pain (OR=1.83) and patchy block (OR=4.37) were significantly associated with re-siting. The areas-under-curves of two multivariate models were 0.894 and 0.806 respectively. CONCLUSION: In our institution, the incidence of epidural catheter re-siting was low in all patients. However, the majority of patients whose catheters were re-sited had exhibited breakthrough pain. The risk factors associated with the need for re-siting of catheters in all patients differed from those who had breakthrough pain.

ASA Grade and Elderly Patients With Femoral Neck Fracture.

PURPOSE: This prospective study was designed to evaluate the effect of American Society of Anaesthesiologists (ASA) score on time to surgery, length of hospital stay, and 30-day mortality in elderly patients with femoral neck fracture. METHODS: A total of 249 patients admitted with femoral neck fracture were included in the study. Mean age was 84 years (95% confidence interval 83 to 85). Two patients were ASA I, 110 patients were ASA II, 125 were ASA III, and 12 were ASA IV. RESULTS: The mean time to surgery was 18.9 hours for ASA I patients, 34.4 hours for ASA II patients, 42.8 hours for ASA III patients, and 61 hours for ASA IV patients (P = .005). The mean hospital stay was 11.5 days (6.3-15.2) for ASA I patients, 17.6 days (4.2-98.8) for ASA II patients, 22.9 days (4.1-120.3) for ASA III patients, and 29 days (2.4-86.0) for ASA IV patients (P = .026); 85% of the patients who died within 30 days of admission were of ASA III-IV. CONCLUSION: Our study shows that patients with higher ASA score have delay in surgery, longer hospital stay, and increase in 30-day mortality. We conclude that ASA grade is a simple and effective tool to predict the above-mentioned outcomes in these patients.