Doctors say lack of communication about epidural shortage is ‘frustrating’

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A shortage of epidural tubes used to deliver pain medication primarily during labor and delivery is affecting most provinces, but supply issues appear to be worse in Western Canada, says Canadian Anesthesiologists’ Society vice president .

Dr. Lucie Filteau said “rumblings” of a shortage of tubes, or catheters, began recently on a private online page of about 300 anesthesiologists across the country.

“We thought there were just small isolated pockets, and people started to realize that it was more prevalent,” said Filteau, an anesthesiologist at The Ottawa Hospital.

She said an apparent lack of information about the shortage from manufacturers to Health Canada and from governments to healthcare providers has been “frustrating, basically in all directions” due to the lack of a coordinated approach. for all provinces and territories.

British Columbia, Alberta, Saskatchewan and Manitoba appear to be hardest hit by the shortage, Filteau said.

“If the shortage is global, maybe it wouldn’t change anything. But I think on the communication side, on the supply chain side and the protocols that exist, there is room for improvement.

The absence of multiple vendors, if so, could create a “perfect storm” involving equipment that is also used to relieve patients’ pain after major chest or abdominal surgery, Filteau said.

A Health Canada report listing medical device shortages says an epidural catheterization kit and set used to administer anesthesia implicates a manufacturer, Arrow International LLC of Pennsylvania. It says a shortage that started on July 18 is expected to last until the end of December.

Health Canada could not immediately respond when asked if the manufacturer had informed it of an impending shortage.

On average, about 50-60% of pregnant women in Canada rely on epidurals to manage pain. The highest utilization, up to 80%, is in urban areas where more anesthesiologists are available to provide this service, especially to those having their first baby, Filteau said.

“If you have your second or third baby and you’re about to bring it out, then it’s not used as often.”

The tube allows an anesthesiologist to deliver painkillers into the epidural space around the spinal cord and nerve roots to create a band of numbness around the lower body, while still allowing someone to push when they are time to give birth.

Nitrous oxide, or laughing gas, could also be used, along with morphine or fentanyl, or local anesthesia if a catheter isn’t available, Filteau said.

Although these techniques help with “relief”, they are not as effective as an epidural, which is the gold standard for continuous pain relief, for hours or days, compared to a single injection, a- she added.

“I think women should adjust their expectations about their birth plan and the degree of pain relief they can expect,” she said of those who fear enduring pain.

Filteau said women should consider childbirth coaches and learn about alternatives to prepare in case an epidural cannot be provided.

“I would suggest that they don’t flood their family doctor’s offices with phone calls, or their obstetricians with phone calls, because they won’t be able to help them with knowledge about accessing epidurals. . »

The Canadian Anesthesiologists’ Society has communicated by email with members across the country and is planning a webinar next week to examine alternative pain relief techniques, Filteau said.

“It is going to be difficult for us to deal with a potentially triage-type situation. Nobody wants to be in this position involving the ethical, moral, medical, legal aspect of withholding care for lack of resources. As practitioners, as providers of pain relief, we are quite upset that we do not have the tools we need to provide the standard of care that Canadians expect.

Jen Allan, a Vancouver doula, said one of her clients requested an epidural at BC Women’s Hospital last week, but the anesthesiologist didn’t seem to be concerned about a shortage of equipment at the time. the.

Shortages in the future would be “worrying”, Allan said.

“We have a diverse skill set on how to support clients through natural childbirth. That said, obviously it would be of great concern because it would have to be available to anyone giving birth if they decide to use it,” she said, adding that an epidural is used for most caesarean births.

“If this is really going to affect people locally, I think there are a lot of women who will be very anxious because the epidural rate at BC Women’s (Hospital) is 80 percent.”

The Provincial Health Services Authority said the rate of epidurals at the hospital was around 50 per cent and it had around 1,300 epidural tubes in stock, enough to last “several months”.

The Saskatchewan Health Authority said a supply chain issue could affect healthcare teams’ ability to provide epidurals to pregnant women and those who may need them after major surgery.

“The (health authority) is working to secure more supplies and ensure care teams make optimal use of existing supplies,” it said in a statement. “During pregnancy, there are several medical considerations where the use of an epidural improves the health and well-being of both mother and baby. It is essential that the supply be maintained to reduce risk to these patients.

Camille Bains, The Canadian Press

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