Anesthesiology NewsPractice-Changing Papers In Obstetric Anesthesia

“These papers will change your practice,” said Pervez Sultan, MD, an associate professor of anesthesia at Stanford University School of Medicine.

In a recent comprehensive review presented at the American Society of Anesthesiologists’ 2023 annual meeting, leading experts highlighted pivotal studies that are set to redefine practices in obstetric anesthesia. These studies offer crucial insights into post-dural puncture headaches, epidural effects on gastric emptying, tranexamic acid usage, quality metrics, intra-operative pain management, and the analgesic efficacy of dexamethasone, marking significant strides in enhancing patient care and informing clinical decisions.

Key Points:

• Chronic Headaches Post-Dural Puncture: A review highlighted that a “wet tap” during labor is linked to a 38% incidence of chronic headaches, urging a reevaluation of patient follow-up and management strategies to mitigate long-term complications.
• Epidural Analgesia and Gastric Emptying: Research using gastric ultrasound revealed that while gastric emptying is slower in pregnant women, epidural analgesia does not exacerbate this delay, prompting a reexamination of fasting guidelines in labor.
• Tranexamic Acid in Postpartum Hemorrhage: The TRACES study demonstrated a dose-response relationship with tranexamic acid in managing postpartum hemorrhage, supporting the 1-g IV dose as effective for antifibrinolysis.
• ASA Quality Metrics for Obstetric Anesthesia: New quality metrics introduced by the ASA aim to guide improvement initiatives in obstetric anesthesia, emphasizing the need for precise measurement in quality enhancement efforts.
• Management of Intra-operative Pain During Cesarean: Emerging research and expert consensus highlight the criticality of addressing breakthrough pain during cesarean sections to improve patient outcomes and potentially reduce PTSD risks.
• Dexamethasone for Post-Cesarean Pain: A systematic review indicates that dexamethasone can extend analgesia duration and reduce pain scores post-cesarean, suggesting its inclusion in postoperative care for non-diabetic patients.

“Our patients deserve to know that chronic headache is a possible long-term complication, and we need to focus on closely documenting our management of spinal headaches and tracking patients longer to understand how we might mitigate the risk of chronic headache.”
– Michaela Farber, MD, Associate Professor of Anesthesia at Harvard Medical School and the Chief of the Division of Obstetric Anesthesia at Brigham and Women’s Hospital

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