title: Combined Spinal Epidural Technique for Labor Analgesia Does Not Delay Recognition of Epidural Catheter Failures: A Single-center Retrospective Cohort Survival Analysis.
abstract: It is unclear whether recognition of epidural catheter failures is delayed with combined spinal epidural technique (CSE) compared to traditional epidural technique (EPID) when used for labor analgesia. The authors hypothesized that recognition of failed catheters is not delayed by CSE.
  
  
  
  Anesthetic, obstetric, and quality assurance records from 2,395 labor neuraxial procedures (1,440 CSE and 955 EPID) performed at Forsyth Medical Center (Winston-Salem, North Carolina) between June 30 and December 31, 2012, were retrospectively analyzed. The primary outcome was catheter survival (failure-free) time during labor analgesia. A proportional hazards model with the counting method was used to assess relationships between the techniques and survival (failure-free) time of catheters, while controlling for subjects' body mass index and providers' level of training in the final best-fit multivariable regression model.
  
  
  
  Cumulative incidence of epidural catheter failures was 6.6% for CSE and 11.6% for EPID (P = 0.001). In the multivariable regression model, catheters placed with CSE versus epidural were less likely to fail (hazard ratio, 0.58; 95% CI, 0.43 to 0.79; P = 0.0002) for labor analgesia. Among the catheters that failed, there was no overall difference in failure time course between the techniques (hazard ratio, 1.17; 95% CI, 0.89 to 1.54; P = 0.26) even though more failed catheters with CSE (48.4%) than with EPID (30.6%) were recognized within the first 30 min of placement (P = 0.009).
  
  
  
  In this cohort, CSE has a significantly lower risk of overall epidural catheter failures than EPID and does not delay recognition of epidural catheter failures. Choice of CSE versus EPID should be based on overall risk of failure, efficacy, and side effects.
authors.affiliation: From the Section of Obstetric Anesthesia, Department of Anesthesiology (J.M.B., J.C.P., V.H.R., L.C.H., P.H.P.) and Department of Biostatistical Sciences (G.B.R.), Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Booth
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Pan
authors.forename: Vernon H
authors.initials: VH
authors.lastname: Ross
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Russell
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Harris
authors.forename: Peter H
authors.initials: PH
authors.lastname: Pan
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000295:instrumentation* / Q000379:methods; D016362:Analgesia, Obstetrical / Q000295:instrumentation* / Q000379:methods; D000775:Anesthesia, Spinal / Q000295:instrumentation* / Q000379:methods; D057785:Catheters; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D009657:North Carolina; D011247:Pregnancy; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors