Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section*

Orbach‐Zinger, Sharon; Friedman, Leonid; Avramovich, Aharon; Ilgiaeva, N.; Orvieto, Raoul; Sulkes, Jacqueline; Eidelman, Leonid A.

doi:10.1111/j.1399-6576.2006.01083.x

Cited by 38 publications

(20 citation statements)

References 18 publications

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“…The success rate for conversion is high; however prolonged duration of labour analgesia, repeated need of clinician administered bolus doses and obesity are factors suggested to increase the risk of failure 20, 21 . Lidocaine with adrenalin with fentanyl supplementation is commonly used for conversion 18 .…”

Section: Discussionmentioning

confidence: 99%

The decision to delivery interval in emergency caesarean sections: Impact of anaesthetic technique and work shift

et al. 2017

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Background: One important task of the emergency anaesthesia service is to provide rapid, safe and effective anaesthesia for emergency caesarean sections (ECS). A Decision to Delivery Interval (DDI) <30 minutes for ECS is a quality indicator for this service. The aim of this study was to assess the DDI and the impact of chosen anaesthetic technique (general anaesthesia (GA), spinal anaesthesia (SPA) with opioid supplementation, or “top-up” of labour epidural analgesia (tEDA) with local anaesthesia and fentanyl mixture) and work shift for ECS at Danderyds Hospital, Sweden. Methods: A retrospective chart review of ECS at Danderyds Hospital was performed between January and October 2016. Time between decision for CS, start of anaesthesia, time for incision and delivery, type of anaesthetic technique, and time of day, working hours or on call and day of week, Monday – Friday, and weekend was compiled and analysed. Time events are presented as mean ± standard deviation. Non-parametric tests were used. Results: In total, 135 ECS were analysed: 92% of the cases were delivered within 30 minutes and mean DDI for all cases was 17.3±8.1 minutes. GA shortened the DDI by 10 and 13 minutes compared to SPA and tEDA (p<0.0005). DDI for SPA and tEDA did not differ. There was no difference in DDI regarding time of day or weekday. Apgar <7 at 5’ was more commonly seen in ECS having GA (11 out of 64) compared to SPA (2/30) and tEDA (1/41) (p<0.05). Conclusion: GA shortens the DDI for ECS, but the use of SPA as well as tEDA with opioid supplementation maintains a short DDI and should be considered when time allows. Top-up epidural did not prolong the DDI compared to SPA. The day of week or time of ECS had no influence on the anaesthesia service as measured by the DDI.

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Section: Discussionmentioning

confidence: 99%

The decision to delivery interval in emergency caesarean sections: Impact of anaesthetic technique and work shift

et al. 2017

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“…Pan et al 10 found that 93.5% of caesarean sections were performed under regional anaesthesia and 41% of pre-existing labour epidural catheters were used for caesarean section, reflecting the common practice of extending block in the presence of a functioning epidural catheter. We were careful to exclude parturients with recurrent breakthrough pain and those with recent intrapartum epidural supplementation, because these cases have been associated with a higher risk of failure to adequately extend labour analgesia 11 . Bupivacaine and levobupivacaine were found to have similar potency in both in vitro and in vivo studies 12,13 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2% Lignocaine with Adrenaline and Fentanyl, 0.75% Ropivacaine and 0.5% Levobupivacaine for Extension of Epidural Analgesia for Urgent Caesarean Section after Low Dose Epidural Infusion during Labour

Sng

Pay

Sia

2008

Anaesth Intensive Care

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Low dose local anaesthetic and fentanyl epidural solutions are commonly 'topped-up' for urgent caesarean section. However, the block characteristics associated with newer local anaesthetics such as ropivacaine 0.75% and levobupivacaine 0.5% have not been fully determined. In a randomised double-blinded controlled clinical trial, we compared 2% lignocaine with adrenaline and fentanyl (LAF), 0.75% ropivacaine and 0.5% levobupivacaine for extension of low dose epidural analgesia for urgent caesarean section in 90 Asian parturients. There was no significant difference in the median, interquartile range, time to T4 loss of sensation to cold between LAF (9.5, 7.0 to 13.3 minutes), 0.75% ropivacaine (10.0, 7.0 to 15.0 minutes) and 0.5% levobupivacaine (10.0, 7.0 to 15.0 minutes). No woman required conversion to general anaesthesia. The supplementation rate did not differ between groups. Levobupivacaine provided a longer duration of sensory block compared to LAF, but a similar duration to 0.75% ropivacaine. Under the conditions of this study there was no significant difference in time to surgical readiness (defined as loss of sensation to cold to T4) between LAF, 0.75% ropivacaine and 0.5% levobupivacaine groups. Ropivacaine and levobupivacaine are suitable alternatives for extending epidural analgesia for urgent caesarean section.

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“…Several previous studies investigated the characteristics and predictive factors for failure of neuraxial anesthesia, 13,18 focusing on the failure of augmentation of labor epidural analgesia for CD. 19,20,24 Unfortunately, there is no standardized definition of epidural failure in the literature, which may explain the wide range of reported epidural failure rates. 25 Another reason for discrepancies may be including different types of failures such as epidural analgesia failure during labor or epidural anesthesia failure during CD.…”

Section: Discusssionmentioning

confidence: 99%

Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients

Kula

Riess

Ellinas

2017

Journal of Clinical Anesthesia

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Study Objective: Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of “difficulty” and “failure” of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement. Design: Single center retrospective chart review. Setting: Labor and Delivery Unit of an inner city academic teaching hospital. Patients: 2485 parturients, ASA status 2 to 4, receiving labor epidural analgesia for anticipated vaginal delivery. Interventions: none. Measurements: We reviewed quality assurance and anesthesia records over a 12-month period. “Failure” was defined as either inadequate analgesia or a positive test dose, requiring replacement, and/or when the anesthesia record stated they failed. “Difficulty” was defined as six or more needle redirections or a note indicating difficulty in the anesthesia record. Main Results: Overall epidural failure and difficulty rates were 4.3% and 3.0%, respectively. Patients with a BMI of 30 kg/m2 or higher had a higher chance of both failure and difficulty with two and almost three fold increases, respectively. Regression analysis indicated that failure was best predicted by BMI and less provider training while difficulty was best predicted by BMI. Additionally, increased BMI was associated with increased time of discovery of epidural catheter failure. Conclusions: Obesity is associated with increasing technical difficulty and failure of neuraxial analgesia for labor. Practitioners should consider allotting extra time for obese parturients in order to manage potential problems.

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Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section*

Abstract: Younger, more obese parturients at a higher gestational week, requiring more top-ups during labor and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.

Cited by 38 publications

References 18 publications

The decision to delivery interval in emergency caesarean sections: Impact of anaesthetic technique and work shift

The decision to delivery interval in emergency caesarean sections: Impact of anaesthetic technique and work shift

Comparison of 2% Lignocaine with Adrenaline and Fentanyl, 0.75% Ropivacaine and 0.5% Levobupivacaine for Extension of Epidural Analgesia for Urgent Caesarean Section after Low Dose Epidural Infusion during Labour

Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients

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