Teaching Neuraxial Anesthesia Techniques for Obstetric Care at Ridge
Hospital in Accra: Achievements and Obstacles
program to improve pain control during labor at Ridge Regional
Hospital in Accra’s maternity
units greatly increased the use of safe and effective spinal
analgesia for women undergoing cesarean section, reports a special
article in the June issue of Anesthesia & Analgesia.
The use of spinal
anesthesia for cesarean delivery increased significantly from 6% in
2006 to 89% in 2009. By 2012, >90% of cesarean deliveries were
conducted with spinal anesthesia, despite a doubling of the number
performed. A trial of spinal labor analgesia was assessed in a small
cohort of parturients with minimal complications; however, protocol
deviations were observed. Although subsequent efforts to provide
spinal analgesia in the labor ward were hampered by anesthesia
provider shortages, spinal anesthesia for cesarean delivery proved
to be practical and sustainable.
demonstrated that spinal labor analgesia can be provided in a
low-resource setting with the development of appropriate protocols,
staff education, and the availability of a few basic drugs," write
Dr. Adeyami J. Olufolabi of Duke University Hospital and colleagues.
They describe their "achievements and obstacles" in working to
implement an effective labor analgesia service at a busy hospital in
Obstetric Anesthesia in Ghana: Lessons and Challenges
paper describes the activities and outcomes of a program to provide
training and support to improve obstetric anesthesia in the
maternity unit of a regional referral hospital in Accra, serving
mainly women with high-risk pregnancies. The program was developed
by Kybele, Inc., a nonprofit humanitarian organization that works to
improve maternal and newborn care in low-income countries.
initial visits, teams of medical volunteers found "generally
adequate" supplies of anesthetic drugs at the study hospital.
However, they also found problems related to understanding and
appropriate use of pain control during labor. In particular,
cesarean section was usually performed with general (inhaled)
anesthesia, which carries a significantly higher risk of
complications compared to neuraxial (spinal or epidural) anesthesia.
Anesthesia leaders offered practical training in spinal anesthesia
for cesarean delivery. This included the development of a
single-shot spinal labor analgesia technique using "pencil-point"
needles -- a simpler and safer alternative to more complex epidural
analgesia techniques. Hospital personnel were also offered training
in preanesthetic evaluation, patient assessment, and handling
problems such as blood pressure drops and inadequate anesthesia.
the first three years of the program, use of spinal anesthesia for
cesarean section increased dramatically: from six percent to over 89
percent of procedures. In subsequent years, spinal anesthesia rates
rose to 95 percent or higher. These gains were sustained even as the
annual number of cesarean deliveries more than doubled.
collaboration yielded other improvements as well, including a
preanesthesia clinic, recruitment of additional anesthesia staff,
initiation of a nurse anesthesia training program, and creation of
an obstetric and postanesthesia care unit. Over five years, overall
maternal mortality rate at the study hospital decreased by 23
anesthesia also saved considerable resources, compared to general
anesthesia. In addition to the availability of safe and effective
anesthesia, mothers appreciated being able to remain conscious
during cesarean section, since it allowed them to find out the
baby's sex immediately after delivery.
labor analgesia program was successful due to support from obstetric
and nursing staff as well as hospital administrators, with
"concerted and sustained advocacy efforts at individual and
departmental levels," the researchers write. They also encountered
some challenges to the program's sustainability -- especially
related to manpower, cultural, and logistical constraints.
"Anesthesia providers bring a unique set of skills to the care of
high-risk obstetric patients, well-recognized in high-resource
countries," Dr. Olufolabi and coauthors conclude. "We must work to
overcome barriers that prevent broader roles for involvement of
anesthesia providers in maternal and neonatal care in low-resource
International Anesthesia Research Society (IARS). "Labor analgesia
in low-income countries: Experience from Ghana." ScienceDaily.
ScienceDaily, 26 May 2015.