Epidural analgesia in obstetrics - a survey of information and documentation

Epidural analgesia (EA) is one of the preferred methods of labour analgesia. The aim of the present survey was to evaluate current practice of risk information, informed consent, monitoring and documentation off obstetric EA. Questionnaires were sent to 1050 departments of anaesthesia in Germany, and 583 (55.5%) hospitals replied. In 89.8% of the responding hospitals EA was performed for vaginal delivery. In 70% of the anaesthetic departments informed consent for EA was obtained, when the parturients were already in active labour, Written informed consent was performed in 69.8% of the patients. However, from those in active labour; in 26.1% of the departments only oral informed consent was obtained. In general, risk information included accidential dural puncture (82.1%), headache (89.4%), insufficient analgesia (74%), infection (63%) and nerve injury (69.8%). Severe, but rare complications such as paraplegia were discussed by a minority of the departments (27.4%). Monitoring of vital parameters was performed in most units, however, pain scores or pain relief obtained by EA were routinely measured in 14.6% of the delivery units, only. A detailed documentation of adverse events and side effects was not common practice. Risk information and consent for EA in obstetrics did not meet the legal standards in many departments of anaesthesia in Germany, Further improvements concerning risk information and informed consent of obstetric EA are necessary. Monitoring and systematic documention of EA as well as instruments of quality control have to be implemented. A closer co-operation of anaesthetists and obstetricians seems to be advisable.