Racial and Ethnic Disparities in Use of Epidural Blood Patch for Pain Relief in Obstetric Patients

PainRelief.com Interview with:
Allison Lee, MD, MS  
[she/her/hers]
Associate Professor of Anesthesiology
Division of Obstetric Anesthesia
Officer of Diversity, Equity and Inclusion, Department of Anesthesiology
Medical Director of the Margaret Wood Center for Simulation and Education
Columbia University Medical Center
New York, NY 10032

Dr. Lee

PainRelief.com:  What is the background for this study? 

Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:

  • Lower labor epidural rates, despite it being the most effective modality for pain relief.
  • Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
  • Worse management of pain after cesarean delivery

Given the importance of effective management of postdural puncture headache and in light of growing evidence of  complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.

Knee Arthritis: Racial Differences in Treatment Patterns and Health Care Expenditures

PainRelief.com Interview with:
Stuart L. Silverman MD FACP FACR
Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine
Medical Director, OMC Clinical Research Center
Beverly Hills, CA 90211

Dr. Silverman

PainRelief.com:  What is the background for this study?

Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status.  Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients. 

Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors.  Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA.  Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.

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