Epidural Choice Appears Independent of Ethnicity


WASHINGTON — When equal access to epidural anesthesia is available, patient ethnicity is not a factor in choosing whether to have an epidural, according to results of a study of 797 consecutive women with singleton pregnancies at a hospital in Flushing, N.Y.

Although epidural anesthesia is widely available in the United States, previous studies have suggested that ethnic disparities persist in the provision of epidurals, according to Dr. Isaac P. Lowenwirt of the New York Hospital Queens, Flushing.

To describe the use of epidural anesthesia during labor in a multiethnic population, Dr. Lowenwirt and his colleagues conducted a prospective study of 800 consecutive singleton pregnancies at a single hospital.

The average age of the women across all ethnic groups ranged from 27 to 32 years. Women who had multiples, malpresentation, or planned cesarean deliveries were excluded from the study.

Complete data from 797 women were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The women were offered three options: parenteral fentanyl, patient-controlled anesthesia (bupivacaine), or no medication. The severity of pain was measured with a visual analog scale.

Overall, 82% of the patients chose an epidural.

The average baseline pain scores were higher among the women who chose an epidural, compared with those who did not (8.8 vs. 3.7). But there was no significant difference in epidural use among the ethnic groups, and patients in all groups reported similarly effective pain relief after epidural placement.

The ethnic groups were defined as white (103 patients), black (78 patients), Hispanic (150 patients), Chinese or Korean (338 patients), Indian (67 patients), and other ethnicities (61 patients).

Socioeconomic factors and maternal education were not factors in the use of an epidural, Dr. Lowenwirt reported.

In addition, nulliparous women were four times more likely to choose an epidural than multiparous women, regardless of ethnicity.

On further analysis, Chinese or Korean patients averaged the shortest duration of analgesia, and black patients averaged the longest duration (141 minutes vs. 185 minutes).

And there was a significant difference in average bupivacaine use between the group with the highest use (Hispanic patients) and the lowest use (Chinese or Korean patients).

The Hispanic patients who chose bupivacaine averaged 7.3 mg/hr, compared with an average of 5.5 mg/hr for the Chinese or Korean patients who chose bupivacaine, he said..

The results suggest that when equal access to epidural analgesia is available, women of all ethnic groups choose it in similar proportions, compared with no medication, the researchers wrote in the poster.

Dr. Lowenwirt said he had no financial conflicts to disclose.

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