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There’s a global shortage of epidurals — and Australian hospitals are feeling the pinch

More than 40 per cent of people who give birth in Australia use epidurals for pain relief during labour.

That amounts to around 92,000 epidurals a year. They’re also used for pain relief outside obstetrics.

However, Australia is feeling the effects of a global supply shortage of particular brands of epidural kits. While this shortage was expected to be resolved at the end of last month, a spokesperson for the Therapeutic Goods Administration (TGA) said it would continue beyond July.

Health authorities are reportedly distributing stock to affected hospitals and working to secure additional kits, while the TGA is investigating how it can “allow [the] supply of alternative products to meet market demand”.

In the meantime, Victorian and NSW health authorities recommend conserving epidural kits for obstetric patients.

Remind me, what’s an epidural?

An epidural for people in labor is an anesthetic procedure used to deliver nerve-blocking drugs, via a tiny plastic tube, into the “epidural space” in the back, through which spinal nerves travel. They’re performed by anaesthetists, who are specialist doctors.

The doctor first identifies the epidural space using a needle and a specially designed syringe, then passes a small tube into the space.

Medications — usually local anesthetics and morphine-like drugs — are administered down the tube. Pain relief is usually achieved within about 20 minutes.

Global supply chain problems will remain with us for many years and we need to be prepared for them.(AAP: Carla Gottgens)

Why is there a shortage of epidurals?

In April, one of the leading international manufacturers of epidurals announced a temporary disruption to its supply.

This specific supply chain issue relates to the lack of supply of blue dye some manufacturers use to color the special low-friction plunger-style epidural syringe. This syringe is important because anaesthetists use it to identify the epidural space in the patient’s back.

The syringe is usually filled with saline and connected to the hollow epidural needle, which is then slowly advanced into the back.

The anesthetist places constant pressure on the syringe and when the epidural space is located, there is a “loss of resistance”. The saline passes easily into it, opening up this space so the epidural catheter can smoothly be passed into it.

A screenshot of an epidural kit showing the blue color of the syringe
Dye to color the blue syringes is in low supply. (Supplied: smiths-medical.com)

The familiar blue color of the low-friction syringe distinguishes it from other syringes, which are clear and used for injecting medications. The coloring of the syringe ensures ease of identification and safety so the correct syringe is used for the procedure.

This unpredictable and sudden loss of a brand of epidural kits has put global pressure on other manufacturers of epidural kits, and their component parts, resulting in a worldwide shortage.

How epidurals have changed

Epidurals have been commonly used for pain relief in childbirth for more than 40 years although the history of epidurals dates back more than 100 years.

When first introduced, epidurals were known as “heavy epidurals”, where high-dose anesthetic drugs blocked the large muscle nerves as well as the smaller pain, temperature and balance nerves. Blocking the nerves to the muscles meant patients were unable to move about their birthing bed, making it difficult to push, and making them feel heavy.

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