title: Implementation of epidural analgesia for labor: is the standard of effective analgesia reachable in all women? An audit of two years.
abstract: BACKGROUND
  Social and cultural factors combined with little information may prevent the diffusion of epidural analgesia for pain relief during childbirth. The present study was launched contemporarily to the implementation of analgesia for labor in our Department in order to perform a 2 years audit on its use. The goal is to evaluate the epidural acceptance and penetration into hospital practice by women and care givers and safety and efficacy during childbirth.
  
  
  METHODS
  This audit cycle measured epidural analgesia performance against 4 standards: (1) Implementation of epidural analgesia for labor to all patients; (2) Acceptance and good satisfaction level reported by patients and caregivers. (3) Effectiveness of labor analgesia; (4) No maternal or fetal side effects.
  
  
  RESULTS
  During the audit period epidural analgesia increased from 15.5% of all labors in the first trimester of the study to 51% in the last trimester (p < 0.005). Satisfaction levels reported by patients and care givers were good. A hierarchical clustering analysis identified two clusters based on VAS (Visual Analogue Scale) time course: in 226 patients (cluster 1) VAS decreased from 8.5±1.4 before to 4.1±1.3 after epidural analgesia; in 1002 patients (cluster 2) VAS decreased from 8.12±1.7 before (NS vs cluster 1), to 0.76±0.79 after (p < 0.001 vs before and vs cluster 2 after). No other differences between clusters were observed.
  
  
  CONCLUSIONS
  Present audit shows that the process of implementation of labor analgesia was quick, successful and safe, notwithstanding the identification of one cluster of women with suboptimal response to epidural analgesia that need to be further studies, overall pregnant womens'adhesion to labor analgesia was satisfactory.
authors.affiliation: Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy.
authors.forename: P L
authors.initials: PL
authors.lastname: Pugliese
authors.forename: G
authors.initials: G
authors.lastname: Cinnella
authors.forename: P
authors.initials: P
authors.lastname: Raimondo
authors.forename: A
authors.initials: A
authors.lastname: De Capraris
authors.forename: P
authors.initials: P
authors.lastname: Salatto
authors.forename: D
authors.initials: D
authors.lastname: Sforza
authors.forename: R
authors.initials: R
authors.lastname: Menga
authors.forename: A
authors.initials: A
authors.lastname: D'Ambrosio
authors.forename: R N
authors.initials: RN
authors.lastname: Fede
authors.forename: C
authors.initials: C
authors.lastname: D'Onofrio
authors.forename: L
authors.initials: L
authors.lastname: Consoletti
authors.forename: A
authors.initials: A
authors.lastname: Malvasi
authors.forename: A
authors.initials: A
authors.lastname: Brizzi
authors.forename: M
authors.initials: M
authors.lastname: Dambrosio
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods* / Q000592:standards*; D016362:Analgesia, Obstetrical / Q000379:methods* / Q000592:standards*; D001034:Apgar Score; D002585:Cesarean Section; D016000:Cluster Analysis; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D010147:Pain Measurement; D010298:Parity; D061214:Patient Safety; D017060:Patient Satisfaction; D011247:Pregnancy