Title: Complications and effectiveness of neuroaxial anesthesia for labor in patients under 17 years old in a tertiary university hospital

Author(s): Diaz A., Martin A., Guasch E., Gredilla E., Gilsanz F.

Institute(s):Anesthesia and Reanimation Department. University Hospital “La Paz”, Madrid. Spain

Text: Background and Goal of Study: Due to the changing sociocultural conditions in recent years, early pregnancy has become a major public health problem extending to the pediatric age.
The aim of our study was to analyze the complications and effectiveness of the neuroaxial anesthesia (NA) as an analgesia labor (L) technique in pregnant women under 17 years old.
Materials and Methods: A retrospective observational study was performed with our own database records for a year (1/12 / 2015-1 / 12/2016) in women under 17 years old with NA for L.
Results and Discussion: The total number of NA during the studied period was 4154 of which 27 (0.65%) were on women under 17 years old: 16 years = 23 (85,19%); 15 years = 3 (11.11%); 14 years = 1 (3.70%). Only one patient presented uncontrolled pregnancy (age = 16 years). The 27 patients (100%) requested NA themselves; A total of 25 (92.59%) women received an epidural analgesia (EA) and 2 (7.41%) combined spinal and epidural analgesia (CSE).
Complications during the procedure were: paresthesias n = 4 (14.81%) and hematic puncture n = 1 (3.70%). There weren´t any accidental dural puncture in women under 17 years old.
Complications at 24 hours were: pain at the puncture site n = 3 (11.11%) and lumbar pain n = 1 (3.7%). One patient (n = 1, 3.7%) presented unilateral femoral hypoesthesia that was resolved after 48 hours.
Regarding effectiveness: one patient needed a catheter resite due to failure, performing a CSE (n = 1, 3.7%); and 2 patients required a rescue bolus (n = 2, 7.41%). Global satisfaction was ≥ 7/10 in 100% of patients.
In our hospital the rate of neuroaxial block repuncture is 1.8% (1), comparable to the studied group. Other series describe failure rates between 0.7% (2) and 23%(3), with no bibliographic data in women under 17 years.
Conclusion(s): The NA for LA is as safe and effective in under 17 population as in the general group. Plus demand of this procedure is very high in this group.

References: 
1. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the ASA Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016, V 124 • No 2 . 
2. Gredilla et al. Medicina Preventiva 2008; 14: 22-37. 
3. De Blas et al. Rev Esp Anestesiol Reanim 2007; 54, 78-85.