A global shortage of epidural tubes, used mainly to deliver pain relief during labour and delivery, has hit four western provinces and has some Ontario hospitals on alert, including in Toronto and Hamilton.
Epidurals are administered through a shot to the spine, and numb the bottom half of the body.
There are other ways to manage pain during birth, such as opioids or laughing gas, but the epidural is considered the “gold standard” both in terms of pain relief and safety, says Dr. Dolores McKeen, the president of the Canadian Anesthesiologists’ Society.
“It’s certainly not desirable for any patient who may be denied what we consider as gold standard,” she said.
Health Canada spokesperson Tammy Jarbeau said in an email that Alberta, Manitoba, Saskatchewan and British Columbia “are experiencing varying degrees of constrained supplies.”
Health Canada is working with provinces and territories “to gather information regarding current supplies of epidural catheters in Canada and to determine whether there is a national shortage.” If it is confirmed, it will “take action if needed to help mitigate the impact of the shortage on patients, which may include exploring access to international supply, if possible.”
In the midst of this shortage, the Saskatchewan Health Authority put out a statement last week, warning that it may impact patients and asking them to review other pain-management options. The Health Authority has also issued triage guidelines, on how to prioritize the highest-risk patients, given the limited supply.
None of the Ontario hospitals the Star surveyed reported limiting or triaging epidurals, but the shortage is something they’re paying close attention to.
No patients have been affected at Unity Health, the hospital network that includes St. Joseph’s and St. Michael’s in Toronto, and patients will continue to get epidurals when needed. But they “should know that “we are working with our anesthetists and suppliers to explore product options in the event the availability changes, and that we continue to monitor the situation closely,” said spokesperson Jennifer Stranges in an email.
A memo from Hamilton Health Sciences leaders to Labour and Delivery and Surgical Teams, sent Friday, noted that some provinces are reporting low supplies of the tube used to deliver pain relief during birth and for some other types of surgery.
“At this time, we have not experienced low supplies in Ontario, however, this is likely to change,” the memo noted.
“Currently, we have sufficient supplies to continue to meet the needs of patients in the short term,” the memo added. But hospital leaders are working with procurement “to secure alternative vendors” and “stabilize” longer-term supplies.
Kingston Health Sciences Centre is also monitoring the shortage and although not limiting procedures at this time, it is “preparing contingency plans should this become a long-lasting shortage,” a spokesperson said in an emailed statement. London Health Sciences Centre is working to “find supply alternatives,” but so far no patients have been affected, a spokesperson confirmed.
According to a report from the Canadian Institute for Health Information, epidurals were used in 59 per cent of vaginal deliveries in 2017-2018.
Epidurals are often used in high-risk pregnancies, in the case of twins, for example, and allow a medical team to quickly pivot to an emergency Caesarean section, if needed, without putting the mom to sleep, added McKeen, who is also a professor of anesthesia at Memorial University, and an obstetrical anesthesiologist.
“So it’s actually a safety strategy that we sometimes will use, particularly if we think a woman is at risk of going to the operating room,” she said. The Canadian Anesthesiologists’ Society has been hearing reports from various regions of changes in the supply for the past few months, but the situation has become more urgent, with some providers out west starting to run short of epidural catheters and kits, she said.
McKeen said they suspect the root of the shortage is “definitely supply chain, most likely fallout from COVID.”
It’s not the first medical essential to be affected by global supply chain shortages. This winter, Ontario hospitals faced a critical shortage of collection tubes required for routine blood work.
Three hospitals in Waterloo region, as reported by the Star’s sister paper The Record last week, still have the supplies in stock, but are working together to “develop a plan to manage next steps,” according to a statement posted on the Grand River Hospital website.
“We are investigating the procurement of substitute options, should they be needed,” the statement added.
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