Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis

Li, Pan; Ma, Xiaoting; Han, Shuang; Kawagoe, Izumi; Ruetzler, Kurt; Lal, Amos; Cao, Longlu; Duan, Ran; Li, Jianli

doi:10.1080/14767058.2023.2278020

The Journal of Maternal-Fetal & Neonatal Medicine

2023

DOI: 10.1080/14767058.2023.2278020

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Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis

Pan Li,

Xiaoting Ma,

Shuang Han

et al.

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2024

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Cited by 4 publications

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Prevention and management of intraoperative pain during Caesarean section

Orbach-Zinger,

Binyamin

2024

BJA Education

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Prevention and management of intraoperative pain during Caesarean section

Orbach-Zinger,

Binyamin

2024

BJA Education

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Conversion to general anesthesia and intravenous supplementation during intrapartum cesarean delivery with an indwelling epidural catheter: a retrospective study

Stav,

Fein,

Matatov

et al. 2024

Reg Anesth Pain Med

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BackgroundIntraoperative pain during cesarean delivery with or without conversion to general anesthesia has been shown to negatively impact maternal and perinatal morbidity. Efforts to reduce these adverse events are a recent focus of obstetric anesthesia care. We aimed to assess rates of and risk factors for conversion to general anesthesia and intraoperative pain during intrapartum cesarean delivery with an indwelling epidural catheter in our academic center.MethodsIn this retrospective cohort study, all women undergoing cesarean delivery with an indwelling epidural catheter between January 2017 and June 2022 were included. Labor epidural analgesia was provided according to a standardized protocol, and conversion to epidural anesthesia was achieved in the operating room before surgery. We determined the conversion rate to general anesthesia and associated risk factors. Second, we examined the rate of administration of analgesics/sedatives and related risk factors in cesarean cases that were not converted to general anesthesia.ResultsAmong the 1192 women undergoing intrapartum cesarean delivery with epidural anesthesia, there were 97 cases with conversion to general anesthesia (8.1%), of which 87 (89.7%) were due to a failed epidural. Higher age, higher weight, and higher gestational age were associated with decreased odds of conversion to general anesthesia. Higher gravidity and longer surgical time were associated with increased odds. An emergent indication was not associated with conversion to general anesthesia. Intravenous analgesic/sedative supplementation occurred in 141 cases (12.9%). Higher age was associated with decreased odds of supplementation, and longer surgical time was associated with increased odds.ConclusionIn our tertiary academic center, the rate of intraoperative conversion to general anesthesia and administration of analgesic/sedative medication among women undergoing intrapartum cesarean delivery with epidural anesthesia was relatively high. Emergency cesarean delivery was not associated with either of the above endpoints.

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Modern methods of regional and postoperative anesthesia during cesarean section: a literature review

Korobka,

Pichugina,

Khazieva

et al. 2024

Regional Anesthesia and Acute Pain Management

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The number of cesarean section (CS) deliveries increases annually in Russia. General anesthesia involves certain risks, including difficult or unsuccessful intubation, aspiration, and infectious and thromboembolic complications. Therefore, regional anesthesia is the method of choice for CS. To date, choosing the most effective method of regional anesthesia remains challenging, including in the postoperative period. Thus, this review aimed to compare the effectiveness of regional anesthesia methods used in CS and identify the most preferred ones for use in clinical practice. The authors conducted a literature search in the electronic databases PubMed (MEDLINE), eLibrary, and Google Scholar using the following keywords and their combinations in English and in Russian: «cesarean section», «neural morphine», «regional analgesia», «epidural analgesia», «peripheral nerve block», nerve block», «paravertebral block», «cesarean section», neuroaxial use of opioids», «regional analgesia», «epidural analgesia», «peripheral nerve blockade», «blockade», and «paravertebral blockade». The search results revealed 3 558 in the PubMed database, 94 in eLibrary, and 2 662 in Google Scholar. The results show that the neuroaxial administration of opioids remains the gold standard of pain relief after CS; however, information on the analgesic effectiveness of new blockades, such as anterior block of the quadratic lumbar muscle and block of the muscle straightening the spine, continues to accumulate.

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Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis

Cited by 4 publications

References 48 publications

Prevention and management of intraoperative pain during Caesarean section

Prevention and management of intraoperative pain during Caesarean section

Conversion to general anesthesia and intravenous supplementation during intrapartum cesarean delivery with an indwelling epidural catheter: a retrospective study

Modern methods of regional and postoperative anesthesia during cesarean section: a literature review

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