ESAIC focused guidelines for the management of the failing epidural during labour epidural analgesia.
作者信息
Brogly Nicolas, Valbuena Gómez Isabel, Afshari Arash, Ekelund Kim, Kranke Peter, Weiniger Carolyn F, Lucas Nuala, Dewandre Pierre-Yves, Guasch Arevalo Emilia, Ioscovich Alexander, Kollmann Andrea, Lindelof Kim, Orbach-Zinger Sharon, Reis Stephanie, van den Bosch Oscar, Van de Velde Marc, Romero Carolina S
机构信息
From the Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón, Calle de O'Donnell, 48, 28009 Madrid, Madrid, Spain (NB), the Servicio de Anestesia, Hospital Universitario Sanitas La Zarzuela, Madrid, c/ Pleyades, 25, 28023 Madrid, Spain (NB), the Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, P° de la Castellana, 261, 28046 Madrid, Spain (IVG), the Department of Paediatric and Obstetric Anaesthesiology, Juliane Marie Centre, Rigshospitalet & Institute of Clinical Medicine, University Hospital of Copenhagen, Copenhagen, Denmark (AA, KL), the University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany (PK, SR), the Division of Anesthesia Critical Care and Pain, Tel Aviv Sourasky Medical Center affiliated with the Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv Israel (CFW), the London North West NHS University Trust, Watford Road, London, UK HA1 3UJ (NL), the Department of Anesthesia & Intensive Care Medicine, Liège University Hospital, Belgium (PYD), the Servicio de Anestesia y Reanimación. Hospital Universitario Fundación Jiménez Díaz. Av. de los Reyes Católicos, 2. 28040 Madrid. Spain (EGA), the Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University, Shmuel Beyth St 12, Jerusalem, 9103102 Israel (AI), the Department of Anesthesia and Intensive Care, Akademiska Sjukhuset, Sjukhusvägen, 75185, Uppsala, Sweden (AK), the Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel affiliated with Tel Aviv University Medical School (SOZ), the Department of Anaesthesiology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands (OvdB), the Department of Cardiovascular Sciences, KU Leuven, and Department of Anaesthesiology, UZ Leuven, Belgium (MvdV), the Department of Anaesthesia, Intensive Care and Pain Medicine, University General Hospital of Valencia, Methodology Department, European University of Valencia, Valencia, Spain (CSR).
出版信息
Eur J Anaesthesiol. 2025 Feb 1;42(2):96-112. doi: 10.1097/EJA.0000000000002108. Epub 2025 Jan 2.
BACKGROUND
Labour epidural analgesia reportedly fails in up to 10 to 25% of cases. A joint taskforce of European Society of Anaesthesiology and Intensive Care (ESAIC) experts was created to develop this focused guideline on the management of failing epidural analgesia in a previously well functioning epidural catheter.
DESIGN
Six clinical questions were defined using a PICO (Population/Intervention/Comparison/Outcome) strategy to conduct a systematic literature search. The questions pertained to clinical management of failing epidural (PICOs 1, 2 and 3), human resource and team training (PICOs 4 and 5) and clinical management of a failing epidural for intrapartum caesarean delivery (PICO 6). The taskforce produced recommendations and clinical practice statements (CPS) and validated them through a Delphi process. The final version of the guideline was submitted to all ESAIC members for critical review and approved by the Guidelines Committee and the ESAIC Board of Directors.
RESULTS
In the initial search, 3737 titles were identified, 93 were retained for complete article analysis and 56 were finally allocated to the PICOs. The full-text analysis of the selected articles precluded extraction of significant data for all PICOs except for PICO 6, for which six articles were identified. Based on the experience, knowledge and opinion of the experts, the task force proposed and validated two recommendations and 11 CPSs.
CONCLUSION
This guideline complemented other recently published expert opinion papers. We hope that this new guidance will serve clinicians to increase parturient safety and quality of care during labour and delivery, while at the same time provide inspiration for further research to fill the current knowledge gaps.
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