Failure rate of labor epidural: An observational study among different levels of trainee anesthesiologists in a university hospital of a developing country

CONTEXT: Frequent use of labor epidural has also led to a corresponding increase in failed epidural analgesia (FEA). AIMS: This study aims to identify the overall rate of FEA and evaluate its association with trainee anesthesiologist at different years/levels of anesthesia residency training. SETTINGS AND DESIGN: Prospective observational study was conducted for one year in the labor room suit of a university hospital. METHODS AND MATERIAL: After university ethics committee approval, full-term parturient receiving labor epidurals and consenting for the study were included. FEA was identified by the presence of one or more set criteria of failure including; pain of numeric rating scale of >4 at 45 minutes after epidural placement, accidental dural puncture, need to re-site the epidural, abandoning the procedure, and maternal dissatisfaction with labor pain relief. STATISTICAL ANALYSIS USED: A binary logistic regression was used to assess the association between failure rate of labor epidural and grades of anesthesiologists. Odds ratio (OR) and 95% confidence interval (CI) were reported. P value ≤0.05 was considered significant. RESULTS: Out of 500 women included, 76 (15.2%) had FEA, which was significantly high in 2(nd) and 3(rd) year residents compared to 5(th) year and above level anesthesiologists [OR = 2.08; 95% CI: 1.17 to 3.67; P = 0.012]. Failure rate was also high but insignificant in 4(th) year residents compared to senior level anesthesiologists [OR = 1.78; 95%CI: 0.89 to 3.53; P = 0.098]. CONCLUSIONS: The incidence of FEA is comparable to those quoted in literature from developed countries and shows association to experience and year of training of anesthesia residents.