J Anesth. 2025 Oct 25. doi: 10.1007/s00540-025-03611-w. Online ahead of print.
ABSTRACT
BACKGROUND: In Japan, labor neuraxial analgesia (LNA) is frequently administered by obstetricians rather than board-certified anesthesiologists, particularly in smaller facilities. Although awareness of maternal safety has increased in recent years, the extent of anesthesiologist involvement in obstetric anesthesia remains unclear.
METHODS: This nationwide cross-sectional study analyzed data from Birth-Navi, a public registry of childbirth facilities maintained by Ministry of Health, Labour and Welfare of Japan. As of August 2024, facilities offering LNA were categorized into two groups: those listing a board-certified anesthesiologist (Group A) and an obstetrician-gynecologist (Group O) as a responsible physician. Institutional characteristics and analgesia practices were compared between groups using chi-square tests.
RESULTS: Among 2063 registered facilities, 837 (40.6%) provided LNA, of which 771 met the inclusion criteria. Only 27.2% facilities listed a board-certified anesthesiologist as the responsible physician. Group A facilities were more likely to be hospitals (86.8% vs. 30.4%, p < 0.001) and more likely to utilize combined spinal-epidural techniques (23.7% vs. 14.0%, p = 0.002). However, 24 h analgesia availability was significantly lower in Group A than in Group O (25.9% vs. 47.1%, p < 0.05). Notably, only 284 facilities (13.8%) provided round-the-clock analgesia upon maternal request.
CONCLUSION: It is important to note that anesthesiologist-led LNA remains limited in Japan. While associated with more advanced techniques, 24 h availability is uncommon. To improve both access and safety, system-level strategies-such as redistribution of personnel and the implementation of collaborative tele-anesthesia networks-should be considered.
PMID:41139167 | DOI:10.1007/s00540-025-03611-w
