ESAIC focused guidelines for the management of the failing epidural during labour epidural analgesia.

Background: Labour epidural analgesia reportedly fails in up to 10 to 25% of cases. A joint taskforce of European Society of Anaesthesiology and Intensive Care (ESAIC) experts was created to develop this focused guideline on the management of failing epidural analgesia in a previously well functioning epidural catheter.

Design: Six clinical questions were defined using a PICO (Population/Intervention/Comparison/Outcome) strategy to conduct a systematic literature search. The questions pertained to clinical management of failing epidural (PICOs 1, 2 and 3), human resource and team training (PICOs 4 and 5) and clinical management of a failing epidural for intrapartum caesarean delivery (PICO 6). The taskforce produced recommendations and clinical practice statements (CPS) and validated them through a Delphi process. The final version of the guideline was submitted to all ESAIC members for critical review and approved by the Guidelines Committee and the ESAIC Board of Directors.

Results: In the initial search, 3737 titles were identified, 93 were retained for complete article analysis and 56 were finally allocated to the PICOs. The full-text analysis of the selected articles precluded extraction of significant data for all PICOs except for PICO 6, for which six articles were identified. Based on the experience, knowledge and opinion of the experts, the task force proposed and validated two recommendations and 11 CPSs.

Conclusion: This guideline complemented other recently published expert opinion papers. We hope that this new guidance will serve clinicians to increase parturient safety and quality of care during labour and delivery, while at the same time provide inspiration for further research to fill the current knowledge gaps.