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Obstetrical anaesthesia in Ontario

Canadian Journal of Anaesthesia volume 42, pages 1117–1125 (1995)Cite this article

Abstract

The purpose of this study was to determine the availability of regional anaesthesia for Caesarean section, of epidural opioids and patient-controlled analgesia after Caesarean section, and of epidural and other forms of analgesia in labour. A mail survey was sent to the “Head Nurse, Department of Obstetrics” at each of the 142 hospitals in Ontario with designated obstetric beds. Responses were obtained from 100% of hospitals. For Caesarean Section, general anaesthesia was used in all hospitals, and was the only option in seven. Epidural anaesthesia was used in 93% of hospitals, and spinal anaesthesia in 48%. Postoperatively, patient-controlled analgesia was used in 31% of hospitals and spinal opioids in 28%. In 66 hospitals, im or iv opioids were the only types of analgesia available. For analgesia in labour, im or iv opioids were used in 96% of hospitals, nitrous oxide was used in 75%, epidural analgesia in 75%, transcutaneous electrical nerve stimulation in 52% and patient-controlled analgesia in 10%. The overall epidural rate was 38%. Although the average rate in the 73 hospitals with fewer than 500 births per year was only 6% 14 large hospitals had an epidural rate of 60% or higher. It is concluded that regional techniques for peripartum analgesia have been widely accepted. Analgesia after Caesarean section could be improved. Epidural analgesia should be more widely available, especially in the many small hospitals in Ontario.

Résumé

Cette étude vise à évaluer pour la césarienne la disponibilité de l’anesthésie régionale, des morphiniques épiduraux et de l’analgésie autocontrôlée après l’intervention, et de l’analgésie épidurale ou autre pendant le travail. Un questionnaire est expédié par la poste à l’infirmière-chef de chacun des 142 hôpitaux de l’Ontario à vocation obstétricale. Tous les hôpitaux ont répondu. Pour la césarienne, l’anesthésie générale est administrée dans tous les hôpitaux et consiste en la seule option dans sept de ceux-ci. L’anesthésie épidurale est utilisée dans 93% des hôpitaux et la rachianesthésie dans 48%. A la période postopératoire l’analgésie autocontrôlée est utilisée dans 31% des hôpitaux et les opiacés par injection rachidienne dans 28%. Dans 66 hôpitaux, seuls les opiacés sont disponibles. Pour l’analgésie pendant le travail, les morphiniques im ou iv sont utilisés dans 96% des hôpitaux, le protoxyde d’azote dans 75%, la stimulation nerveuse électrique transcutanée dans 52% et l’analgésie autocontrôlée dans 10%. Le pourcentage global des épidurales est de 38%. Bien que le taux moyen de 73 hôpitaux de moins de 500 lits par année soit seulement de 6%, 14 grands hôpitaux ont un taux de 60% et plus. En conclusion, l’anesthésie épidurale pour la césarienne est largement acceptée. L’analgésie postcésarienne pourrait être améliorée. L’anesthésie épidurale devrait être beaucoup plus disponible, surtout dans plusieurs petits hôpitaux de l’Ontario.

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Affiliations

  1. Department of Anaesthesia, Orillia Soldiers’, Memorial Hospital, 170 Colbome Street West, L3V 2Z3, Orillia, Ontario

    John Oyston

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  1. John Oyston
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Supported by the physicians of Ontario through the PSI Foundation

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Oyston, J. Obstetrical anaesthesia in Ontario. Can J Anaesth 42, 1117–1125 (1995). https://doi.org/10.1007/BF03015099

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  • DOI: https://doi.org/10.1007/BF03015099

Key words

  • anaesthesia: obstetrical
  • analgesia: obstetrical, epidural