Implementation of a standardized epidural top-up algorithm for inadequate labor epidural analgesia: a single-center retrospective study

Background: We hypothesized that implementation of a labor epidural management algorithm would increase the labor epidural catheter replacement rate at our hospital.

Methods: Our institutional review board approved this study and waived the requirement for informed consent. Patients who had labor epidural analgesia and delivered vaginally or had replacement of an epidural catheter prior to vaginal delivery from August 1, 2022 to December 31, 2022 and from August 1, 2023 to December 31, 2023 were included in the study. Study investigators entered data from the electronic medical record into REDCap.

Results: A total of 530 and 740 patients received labor epidural analgesia and met inclusion criteria before and after implementation of the algorithm, respectively. Patients who received labor epidural analgesia after implementation of the protocol had an absolute increase of 1.0% in the catheter replacement rate, which was not statistically significant (P = 0.34). A multivariate logistic regression found that the number or rescue analgesia boluses (odds ratio 2.68; 95% confidence interval 2.092, 3.434; P < 0.001) and operator level of training (odds ratio 0.41; 95% confidence interval 0.226, 0.743; P = 0.003) were associated with catheter replacement.

Conclusion: After implementation of a labor epidural catheter management algorithm, patients had an increase in labor epidural catheter replacement that was not statistically significant.