Comparing epidural surgical anesthesia and spinal anesthesia following epidural labor analgesia for intrapartum cesarean section: a prospective randomized controlled trial

Abstract

BackgroundThe conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS.MethodsBoth groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In the ESA group (n = 163), ESA was performed with 17 ml of 2% lidocaine mixed with 100 µg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In the SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 µg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups.ResultsThe failure rate of achieving pain-free surgery was higher in the ESA group than the SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between the two groups in the rate of conversion to general anesthesia; however, the rate of analgesic requirement was higher in the ESA group than in the SA group (12.9% vs. 1.3%, P < 0.001). The incidence of high block, nausea, vomiting, hypotension, and shivering and Apgar scores were comparable between the two groups.ConclusionsSA after ELA can lower the failure rate of pain-free surgery during intrapartum CS compared to ESA after ELA.

A comparison of the effects of ENTONOX inhalation and spinal anesthesia on labor pain reduction and apgar score in vaginal delivery: a clinical trial study

“…It is the first simple and repeatable method performed on the newborn baby in the delivery or birthing room a make a quick and accurate assessment of the physical health condition of the newborn baby immediately after delivery so that extra medical and emergency care can be provided if needed. [ 1 , 18 , 19 ]…”

Let us not discard a preexisting epidural catheter for intrapartum cesarean section yet!

“…I read with interest the study by Yoon et al [ 1 ] comparing epidural surgical anesthesia (ESA) and spinal anesthesia (SA) following epidural labor analgesia (ELA) for intrapartum cesarean section (CS). I also read the accompanying editorial by Kim [ 2 ] in which the author raises the question whether a pre-existing epidural catheter should be discarded for an intrapartum CS.…”

“…I also read the accompanying editorial by Kim [ 2 ] in which the author raises the question whether a pre-existing epidural catheter should be discarded for an intrapartum CS. Yoon et al [ 1 ] suggest that ESA for CS has been unsuccessful or fails to achieve a satisfactory block in approximately 1.7–38% of cases, depending upon how failure is defined. They compared the rate of pain-free intrapartum CS performed under ESA and SA after ELA.…”

“…While the failure rate in achieving pain-free surgery was significantly higher in the ESA group than in the SA group (15.3% vs. 2.5%, P < 0.001), there was no statistically significant difference between groups in the rate of conversion to general anesthesia. Yoon et al [ 1 ] excluded patients with less than a 2-hour interval between epidural analgesia top-ups and CS in their study. This implies that when the patients were taken up for CS, the epidural analgesia may have worn off to a large extent.…”

“…Radiographic evidence suggests that the dural sac may be compressed by prior epidural drug administration [ 5 ]. Yoon et al [ 1 ] noted a significantly higher mean phenylephrine requirement in the SA group compared to ELA group (P < 0.001). Thus, when performing SA after a failed epidural or spinal anesthesia, reducing the dose of bupivacaine depending on the extent of the existing blockade should be considered as there is a risk of a high spinal block with associated complications.…”