title: Labor epidural catheter reactivation or spinal anesthesia for delayed postpartum tubal ligation: a cost comparison.
abstract: OBJECTIVE
  To evaluate the costs and resource consumption associated with utilizing epidural catheters placed during labor versus spinal anesthesia for postpartum tubal ligation. To examine maternal demographics, anesthetic management variables, and time interval from delivery until surgery for association with epidural catheter reactivation success rate.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital labor and delivery center.
  
  
  METHODS
  120 consecutive postpartum patients with tubal ligations performed between June 1991 and December 1993.
  
  
  METHODS
  Postpartum women scheduled for tubal ligation with labor epidural catheters in place either had local anesthetic injected via the epidural catheter (n = 45) or had the catheter removed without reinjection and spinal anesthetic administered (n = 20). Patients with inadequate epidural anesthesia went on to receive spinal anesthesia. Women without a labor epidural catheter received spinal anesthesia (n = 55).
  
  
  RESULTS
  Adequate anesthesia for tubal ligation was achieved in 78% of women after reinjection of their epidural catheter. Operating room (OR) and anesthesia times were highest when 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 times associated with epidural catheter reactivation increased patient charges on average of $176 compared with the initial use of spinal anesthesia.
  
  
  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 during labor. Anesthesiologists should weigh the cost advantages of spinal anesthesia against the small, but increased probability of headache after dural puncture.
authors.affiliation: Department of Anesthesiology, University of Vermont College of Medicine, Burlington 05401, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Viscomi
authors.forename: J P
authors.initials: JP
authors.lastname: Rathmell
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural / Q000191:economics* / Q000295:instrumentation; D000773:Anesthesia, Obstetrical / Q000191:economics* / Q000295:instrumentation; D000775:Anesthesia, Spinal / Q000191:economics* / Q000295:instrumentation; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002404:Catheterization / Q000295:instrumentation; D003365:Costs and Cost Analysis; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006295:Health Resources; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007743:Labor, Obstetric; D009873:Operating Rooms / Q000191:economics; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D013246:Sterilization, Tubal; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine