Survey of external cephalic version for breech presentation and neuraxial blockade use.
OBJECTIVE
Neuraxial blockade may increase external cephalic version (ECV) success rates. This survey aimed to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV.


METHODS
We surveyed Society for Obstetric Anesthesia and Perinatology members regarding ECV practice using a 15-item survey developed by 3 obstetric anesthesiologists and tested for face validity. The survey was e-mailed in January 2015 and again in February 2015 to the 1056 Society of Obstetric Anesthesiology and Perinatology members. We present descriptive statistics of responses.


METHODS
Our survey response rate was 322 of 1056 (30.5%).


RESULTS
Neuraxial blockade was used for ECV always by 18 (5.6%), often by 52 (16.1%), sometimes by 98 (30.4%), rarely by 78 (24.2%), and never by 46 (14.3%) of respondents. An anesthetic sensory block target was selected by 141 (43.8%) respondents, and analgesic by 102 (31.7%) respondents. Epidural drug doses ranged widely, including sufentanil 5-25 μg; lidocaine 1% or 2% 10-20 mL, bupivacaine 0.0625% to 0.5% 6-15 mL, and ropivacaine 0.2% 20 mL. Intrathecal bupivacaine was used by 182 (56.5%) respondents; the most frequent doses were 2.5 mg used by 24 (7.5%), 7.5 mg used by 35 (10.9%), and 12 mg used by 30 (9.3%).


CONCLUSIONS
Neuraxial blockade is not universally offered to facilitate ECV, and there is wide variability in neuraxial blockade techniques, in drugs and doses administered, and in the sensory blockade (anesthetic or analgesic) targeted. Future studies need to evaluate and remove barriers to allow for more widespread use of neuraxial blockade for pain relief and to optimize ECV success rates.
Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel. Electronic address: carolynfweiniger@gmail.com.
Carolyn F
CF
Weiniger
Department of Anaesthesia and Perioperative Medicine, University College London Hospital, London, UK. Electronic address: p.sultan@doctors.org.uk.
Pervez
P
Sultan
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA. Electronic address: adunn2@stanford.edu.
Ashley
A
Dunn
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, California, USA. Electronic address: bcarvalho@stanford.edu.
Brendan
B
Carvalho
D000577:Amides / Q000008:administration & dosage; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001946:Breech Presentation / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008012:Lidocaine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D014710:Version, Fetal / Q000379:methods*
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008012:Lidocaine; D017409:Sufentanil; D002045:Bupivacaine
Analgesia; Anesthesia; External cephalic version; Neuraxial blockade