LABOR EPIDURAL CATHETER REACTIVATION OR SPINAL-ANESTHESIA FOR DELAYEDPOSTPARTUM TUBAL-LIGATION - A COST COMPARISON

Study Objectives: To evaluate the costs and resource consumption assoc iated with utilizing epidural catheters placed during labor versus spi nal anesthesia for postpartum tubal ligation. To examine maternal demo graphics, anesthetic management variables, and time interval from deli very until surgery for association with epidural catheter reactivation success rate. Design: Retrospective study. Setting: University hospit al labor and delivery center. Patients: 120 consecutive postpartum pat ients with tubal ligations performed between June 1991 and December 19 93. Interventions: Postpartum women scheduled for tubal ligation with labor epidural catheters in place either had focal anesthetic injected via the epidural catheter (n = 45) or had the catheter removed withou t reinjection and spinal anesthetic administered (n = 20). Patients wi th inadequate epidural anesthesia went on to receive spinal anesthesia . Women without a labor epidural catheter received spinal anesthesia ( n = 55). Measurements and Main Results: Adequate anesthesia for tubal ligation was achieved in 78% of women after reinjection of their epidu ral catheter. Operating room (OR) and anesthesia times were highest wh en epidural catheter reactivation was unsuccessful, intermediate when epidural catheter reactivation was successful, and lowest with initial spinal anesthesia (p < 0.05). The longer OR and anesthesia provider t imes associated with epidural catheter reactivation increased patient charges an average of $176 compared with the initial use of spinal ane sthesia. Conclusions: Spinal anesthesia for postpartum tubal ligation was associated with lower anesthesia professional fees and OR charges compared with attempted reactivation of epidural catheters placed duri ng labor. Anesthesiologists should weigh the cost advantages of spinal anesthesia against the small, but increased probability of headache a fter dural puncture.