IMPACT OF COMPANION PRESENCE DURING PLACEMENT OF NEURAXIAL ANALGESIA

Background: The practice of companion presence during the placement of labor epidural catheters may impact a paturient’s satisfaction and level of anxiety during the procedure.(1) However, the effect of companion presence has not been studied during neuraxial catheter placement for labor analgesia in the United States. In addition, no study has examined the impact of this practice on the parturient or provider anxiety and satisfaction in a teaching institution when trainees are being instructed during the procedure. The purpose of this study was to evaluate the impact of companion presence on maternal and provider anxiety and satisfaction during labor neuraxial catheter placement in a USA teaching institution. Methods: Parturients admitted for labor between December 2016 and April 2017 are considered for enrollment in this study. Inclusion criteria include: nulliparity, spontaneous labor or induction of labor, ASA class < 3, desire to receive neuraxial analgesia for labor. Subjects initially complete four validated questionnaires: State-Trait Anxiety Inventory (STAI), Newest Vital Sign, Pain Catastrophizing Scale, an assessment of knowledge of the procedure. Subjects are randomized to companion present vs. companion absent for the procedure. Following the procedure when the women are comfortable, they repeat the STAI, as well as a post-procedural assessment of satisfaction. The anesthesia provider is also questioned regarding difficulty and anxiety during the procedure. In a pre-study survey the majority of parturients surveyed, 29 of 34, stated that they would choose to have a companion present. Using a two-sided Mann-Whitney-Wilcoxon Test simulation, we determined that a total of 150 patients, 75 per group, would be sufficient to achieve an 81% power to show a difference in means. Results: Over 75% of the total patients required have been recruited. We are expecting to have data collection completed by the end of March, and analysis completed shortly thereafter. The primary outcome of the study will be maternal satisfaction reported at the end of the neuraxial procedure. Secondary outcomes include the level of anxiety when comparing spontaneous and induced women, the effect of maternal preference regarding companion presence on level of anxiety, the effect of health literacy on level of anxiety, the degree of pain catastrophizing on level of anxiety, the effect of ethnicity on level of anxiety, the effect of the relation of the companion to the parturient on level of anxiety, the perceived difficulty for the provider based on the presence of a companion. Discussion: The dynamic relationships between the Anesthesiologist and the trainee, as well as between the Anesthesiologist and the parturient must be balanced to provide the highest quality of patient care. This study will illustrate the role of companion presence during neuraxial labor analgesia on these relationships. 1) Orbach-Zinger, S. et al. Anesth Analg 2012; 114: 654-60.