Postpartum Tubal Ligation: A Retrospective Review of Anesthetic Management at a Single Institution and a Practice Survey of Academic Institutions

Abstract Study objective The 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. Design An 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. Setting Labor and delivery unit. Internet survey. Patients 202 PPTL procedures were reviewed. 47 institutions were surveyed; 26 responses were received. Measurements Timing of PPTL, anesthetic management, postoperative pain and length of stay. Main results There 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 17h [10–25; 3–55] and 28h [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] 41min [33–54] versus 15min [12–21] and 19min [15–24], respectively ( P 8h and >24h post-delivery, respectively. Conclusions Epidural 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.