title: Differences between anticipated and perceived difficulty and insertion duration of labor epidural techniques among anesthesiologists, nurses and patients.
abstract: BACKGROUND
  Difficulty with the labor epidural technique has been described using a variety of criteria, but remains inadequately defined. We sought to determine the reasons cited for difficulty with the insertion of labor epidural techniques among anesthesiologists, nurses, and patients. We hypothesized that the perception of procedural difficulty would correlate among participants and with the elapsed duration of the insertion attempt.
  
  
  METHODS
  A total of 140 participant sets (i.e. anesthesiologist, nurse and patient) were asked to complete a questionnaire on procedural difficulty, immediately before (i.e. anticipated) and after (i.e. perceived) a standardized epidural technique. Procedural duration, using specified start and end times, was recorded in seconds by an independent co-investigator. Demographic data for all groups were recorded.
  
  
  RESULTS
  Perceived difficulty with the epidural technique was similar among all groups (range 10-14%; P=0.29) and correlated with anticipated difficulty (anesthesiologist P=0.0004; nurse P=0.00001; patients P=0.006) and procedural duration (all groups P <0.001). The most common reasons cited for perceived difficulty were procedural duration (anesthesiologist P=0.58), number of attempts (nurse P=0.02), and pain experienced (patient P=0.035).
  
  
  CONCLUSIONS
  Difficulty with the epidural technique is associated with anticipated difficulty and procedural duration. The reasons for perceived difficulty differ among anesthesiologists, nurses and obstetric patients, with patients most commonly citing pain experienced.
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: A
authors: A
authors: Clark
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: G
authors: G
authors: Holck
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: B
authors: B
authors: Mahoney
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: M K
authors: MK
authors: Farber
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: X
authors: X
authors: Liu
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ltsen@zeus.bwh.harvard.edu.
authors: L C
authors: LC
authors: Tsen
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016362:Analgesia, Obstetrical / Q000706:statistics & numerical data*; D000704:Analysis of Variance; D000776:Anesthesiology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D010146:Pain; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Epidural technique; Labor analgesia; Nurse perceptions; Obstetric; Patient perceptions; Procedural difficulty; Procedural duration; Provider perceptions