Efficacy of Labor Epidurals for Postpartum Tubal Ligation

The aim of this research is to determine the effect of postpartum epidural saline infusion on
the reactivation of labor epidural catheters which are used as the anesthetic technique for
PPTL following vaginal delivery. It is proposed that continuous epidural saline infusion will
decrease the incidence of catheter obstruction by preventing clot, fibrosis, or tissue
plugging and therefore improve reactivation rates. To our knowledge, this is a novel method
for attempting to improve epidural reactivation rate and if successful, it would challenge
the current practice of only capping epidurals following delivery and later attempting
reactivation prior to PPTL. This may, possibly, become a new technique used to improve the
rate of epidural reactivation for PPTL.

If study results show improved labor epidural reactivation rates, benefits would include
decreased patient morbidity and greater patient comfort and satisfaction by avoiding the
risks of additional neuraxial procedures as well as general anesthesia. These risks include
difficult or failed intubation, aspiration, hypotension, headache, postoperative nausea and
vomiting, and sore throat. Improving epidural reactivation rate could also result in greater
OR efficiency and decreased costs for the patient and hospital.

The investigators also hope to elucidate factors associated with catheter migration or
dislodgement and subsequent failure of epidural reactivation. Additionally, we hope to
determine what effect obesity and length of time prior epidural reactivation have on epidural
reactivation rates.

Inclusion Criteria:

- Pregnant women

- 18 to 45 years of age

- Admitted to MUSC in labor or for induction of labor resulting in a vaginal delivery
epidural analgesia

- Postpartum tubal ligation following delivery

- American Society of Anesthesiologists (ASA) Physical Class 1, 2, and 3

Exclusion Criteria:

- Critically Ill Patients (patients admitted to the ICU)

- Cognitively Impaired Persons (patients with a diagnosis of cognitive deficit)

- Cesarean delivery

- Punctured dura

- Patients enrolled in other epidural research studies