A 20-YEAR RETROSPECTIVE ANALYSIS OF THE EFFICACY OF EPIDURAL ANALGESIA-ANESTHESIA WHEN ADMINISTERED AND OR MANAGED BY OBSTETRICIANS

OBJECTIVE: The purpose of this study was to retrospectively determine the safety and efficacy of epidural anesthesia when administered by ob stetricians in a community hospital. STUDY DESIGN: 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 wer e displayed graphically to view trends over time. Odds ratios were cal culated to determine the associations of epidural anesthesia with oxyt ocin stimulation, episiotomy, assisted vaginal delivery (forceps or va cuum extraction), and cesarean section. Particular scrutiny was given to any listed complication during labor or delivery. RESULTS: Over the 20-year period epidural anesthesia was administered without serious c omplication by various obstetricians with different training. Techniqu e improved as procedures became standardized, resulting in an increase in the number of epidural procedures over the 20-year period. Inciden ce was also increased among women requiring oxytocin augmentation, epi siotomies, and assisted vaginal deliveries. Of the total number perfor med, <5% of patients required additional anesthesia. CONCLUSION: Over a 20-year period epidural analgesia or anesthesia has been an effectiv e and safe procedure when performed and supervised by obstetricians-gy necologists in a community hospital.