Original ContributionPostpartum tubal ligation: A retrospective review of anesthetic management at a single institution and a practice survey of academic institutions

- A retrospective review revealed a 26% failure rate for epidural reactivation.
- Successful reactivation is most likely within 24 h ideally 8 h after catheter insertion or delivery.
- Reactivation failure significantly prolonged anesthetic induction times.
- A survey of PPTL practice management at academic institutions revealed significant variability in practices.

Study objectiveThe primary aim was to evaluate institutional anesthetic techniques utilized for postpartum tubal ligation (PPTL). Secondarily, academic institutions were surveyed on their clinical practice for PPTL.DesignAn institutional-specific retrospective review of patients with ICD-9 procedure codes for PPTL over a 2-year period was conducted. Obstetric anesthesia fellowship directors were surveyed on anesthetic management of PPTL.SettingLabor and delivery unit. Internet survey.Patients202 PPTL procedures were reviewed. 47 institutions were surveyed; 26 responses were received.MeasurementsTiming of PPTL, anesthetic management, postoperative pain and length of stay.Main resultsThere was an epidural catheter reactivation failure rate of 26% (18/69 epidural catheter reactivation attempts). Time from epidural catheter insertion to PPTL was a significant factor associated with failure: median [IQR; range] time for successful versus failed epidural catheter reactivation was 17 h [10-25; 3-55] and 28 h [14-33; 5-42], respectively (P = 0.028). Epidural catheter reactivation failure led to significantly longer times to provide surgical anesthesia than successful epidural catheter reactivation or primary spinal technique: median [IQR] 41 min [33-54] versus 15 min [12-21] and 19 min [15-24], respectively (P < 0.0001). Fifty-eight percent (15/26) of respondents routinely leave the labor epidural catheter in-situ if PPTL is planned. Sixty-five percent (17/26) and 7% (2/26) would not attempt to reactivate the epidural catheter for PPTL if > 8 h and > 24 h post-delivery, respectively.ConclusionsEpidural catheter reactivation failure increases with longer intervals between catheter placement and PPTL. Failed epidural catheter reactivation increases anesthetic and operating room times. Our results and the significant variability in practice from our survey suggest recommendations on the timing and anesthetic management are needed to reduce unfulfilled PPTL procedures.