title: Risk factors for failed reactivation of a labor epidural for postpartum tubal ligation: a prospective, observational study.
abstract: OBJECTIVE
  To determine specific risk factors that increase the failure rate of labor epidurals reactivated for use as a surgical block for postpartum tubal ligation.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Labor and delivery suite and operating rooms at the Women and Infants Center.
  
  
  METHODS
  One hundred patients undergoing postpartum tubal ligation with an existing labor epidural that is documented to be within 2 cm of initial placement.
  
  
  METHODS
  Body mass index, patient satisfaction with her epidural during labor and delivery, time from delivery to reactivation for tubal ligation, depth to loss of resistance, and the need for top-ups during labor were recorded preoperatively. Failure to reactivate was recorded and defined as any patient that (1) did not achieve a T6level to pinprick, (2) had perceived pain (pain score >3) that required administration of an intravenous opioid or local anesthetic infiltration, or (3) required conversion to general anesthesia.
  
  
  RESULTS
  The overall success rate of reactivation was 78%. Significant risk factors for failure to reactivate were (1) poor patient satisfaction (P = .016), (2) increased time from delivery to reactivation (P = .044), and (3) the need for top-ups during labor and delivery (P = .032).
  
  
  CONCLUSIONS
  Poor satisfaction score of the epidural during labor and delivery, increasing time from delivery to epidural reactivation for tubal ligation, and the need for top-ups during labor and delivery increase the incidence of reactivation failure. No correlation was found with body mass index or loss of resistance and failure to reactivate.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA. Electronic address: mfpowell@uabmc.edu.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Powell
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Wellons
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
authors.forename: Steve F
authors.initials: SF
authors.lastname: Tran
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Zimmerman
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Frölich
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D059408:Pain Management / Q000379:methods*; D017060:Patient Satisfaction; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013246:Sterilization, Tubal / Q000379:methods*; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local
keywords: 2-Chloroprocaine; Epidural anesthesia; Postpartum; Tubal ligation