The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery

Adesope, Oluwaseyi; Einhorn, Lisa M.; Olufolabi, Adeyemi J.; Cooter, Mary; Habib, Ashraf S.

doi:10.1016/j.ijoa.2016.01.007

Cited by 13 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also found that advanced gestational age was linked to failure of SA, whether there had been any epidural space manipulation. Our finding contrasts with reports of inadequate surgical anesthesia for cesarean deliveries in pre-term parturients, even though it was determined that low fetal weight was the main factor implicated 20 . Notably, fentanyl doses above 20 µg were observed overall in the spinal failure group, without being associated to a decrease in corresponding local anesthetic dosage.…”

Section: Discussioncontrasting

confidence: 99%

Neuraxial anesthesia for postpartum tubal ligation at an academic medical center

et al. 2018

View full text Add to dashboard Cite

Background: Use of an in situ epidural catheter has been suggested to be efficient to provide anesthesia for postpartum tubal ligation (PPTL). Reported epidural reactivation success rates vary from 74% to 92%. Predictors for reactivation failure include poor patient satisfaction with labor analgesia, increased delivery-to-reactivation time and the need for top-ups during labor. Some have suggested that this high failure rate precludes leaving the catheter in situ after delivery for subsequent reactivation attempts. In this study, we sought to evaluate the success rate of neuraxial techniques for PPTL and to determine if predictors of failure can be identified. Methods: After obtaining IRB approval, a retrospective chart review of patients undergoing PPTL after vaginal delivery from July 2010 to July 2016 was conducted using CPT codes, yielding 93 records for analysis. Demographic, obstetric and anesthetic data (labor analgesia administration, length of epidural catheter in epidural space, top-up requirements, time of catheter reactivation, final anesthetic technique and corresponding doses for spinal and epidural anesthesia) were obtained. Results: A total of 70 patients received labor neuraxial analgesia. Reactivation was attempted in 33 with a success rate of 66.7%. Patient height, epidural volume of local anesthetic and administered fentanyl dose were lower in the group that failed reactivation. Overall, spinal anesthesia was performed in 60 patients, with a success rate of 80%. Conclusions: Our observed rate of successful postpartum epidural reactivation for tubal ligation was lower than the range reported in the literature. Our success rates for both spinal anesthesia and epidural reactivation for PPTL were lower than the generally accepted rates of successful epidural and spinal anesthesia for cesarean delivery. This gap may reflect a lower level of motivation on behalf of both the patients and anesthesia providers to tolerate “imperfect” neuraxial anesthesia once fetal considerations are removed.

show abstract

Section: Discussioncontrasting

confidence: 99%

Neuraxial anesthesia for postpartum tubal ligation at an academic medical center

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Regional anaesthesia also called epidural or spinal anaesthesia is most commonly used to relief pain throughout birthing process concerns regarding the use and safety of epidural anaesthesia is already well documented. 10 Various theories has been reported to explain the mechanism most common of which is the compression of thecal sac that surrounds the spinal cord that result in dislodgment of intradural dose within cerebrospinal fluid. 7,11 Database analysis proved that, administration of regional anaesthesia sometime leads to poor labour epidural, elevates the chances of block failure 12 as well as other complication as also seen in present study.…”

Section: Discussionmentioning

confidence: 99%

“…8 The other reasons could also be the dose reduction by the clinician to avoid high-block. 9,10 The present study was designed to assess the risk of spinal anaesthesia failure post epidural block given during c-section delivery. An incidence estimate could providently provide the information regarding risk benefit analysis of this procedure for patient's safety and secure delivery.…”

Section: Introductionmentioning

confidence: 99%

Spinal Anaesthesia Failure Risk Followed by Failed Epidural Block in Caesarean Deliveries

Unar¹,

Javaid²,

Dar³

et al. 2021

PJMHS

View full text Add to dashboard Cite

Background: There is a risk associated with spinal anaesthesia failure after immediate deliverance of epidural anaesthesia. Objective: To assess the risk of spinal anaesthesia failure followed by failed epidural block in caesarean deliveries. Study Design: Retrospective study Place and Duration of Study: Department of Obstetrics & Gynaecology, Khairpur Medical College Khairpur Mir’s from 1st July 2020 to 30th June 2021. Methodology: One hundred and seventy labour cases who have been given epidural anaesthesia and were prepared for caesarean section through spinal anaesthesia were included. The demographic and clinical information of each pregnant female was documented. Proper epidural dosage was maintained during labour. Results: The mean age of the patients was 26.5±5.2 years. There was a significant increase in body mass index among epidural converted spinal aesthesia patients. The higher incidence of non-reassuring foetal heart tracing and malpresentation in failure cases were found. Conclusion: There is a 11.17% risk of spinal anaesthetics failure for attaining block height when administered within 30 min of epidural dose. Keywords: Epidural, Spinal anaesthesia, Anaesthesia, Caesarean

show abstract

“…In the obstetric anesthesia literature, the incidence of a failed spinal anesthesia requiring conversion to a GA varies from 0% to 1.9%. 5–10 When the definition of failed spinal anesthesia is expanded to include the need for repeat neuraxial anesthesia or supplemental analgesia, or sedation, the incidence increases to 2.7% to 10.2%. Factors that have been associated with failure in the obstetric population include early gestational age, low birth weight neonate, nulliparity, non-Caucasian ethnicity, urgency of surgery, surgery duration over 90 minutes, postpartum sterilization, needle insertion at the L4/5 vertebral level, >1 neuraxial anesthesia attempt, provider experience, and the absence of intrathecal opioids.…”

mentioning

confidence: 99%

“…Factors that have been associated with failure in the obstetric population include early gestational age, low birth weight neonate, nulliparity, non-Caucasian ethnicity, urgency of surgery, surgery duration over 90 minutes, postpartum sterilization, needle insertion at the L4/5 vertebral level, >1 neuraxial anesthesia attempt, provider experience, and the absence of intrathecal opioids. 5–10…”

mentioning

confidence: 99%

The Incidence and Predictors of Failed Spinal Anesthesia After Intrathecal Injection of Local Anesthetic for Cesarean Delivery: A Single-Center, 9-Year Retrospective Review

Jin

Munro

Aidemouni

et al. 2023

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND:The incidence of failed spinal anesthesia varies widely in the obstetric literature. Although many risk factors have been suggested, their relative predictive value is unknown. The primary objective of this retrospective cohort study was to determine the incidence of failed spinal anesthesia for cesarean deliveries at a tertiary care obstetric hospital, and its secondary objectives were to identify predictors of failed spinal anesthesia in the obstetrics population and quantify their relative importance in a predictive model for failure. METHODS: With local institutional ethics committee approval, a retrospective review of our hospital database identified the incidence of failed spinal anesthesia for 5361 cesarean deliveries between 2010 and 2019. We performed a multivariable analysis to assess the association of predictors with failure and a dominance analysis to assess the importance of each predictor. RESULTS: The incidence of failed spinal anesthesia requiring an alternative anesthetic was 2.1%, with conversion to general anesthesia occurring in 0.7% of surgeries. Supplemental analgesia or sedation was provided to an additional 2.0% of women. The most important predictors of a failed spinal anesthetic were previous cesarean delivery (odds ratio [OR], 11.33; 95% confidence interval [CI], 7.09-18.20; P < .001), concomitant tubal ligation (OR, 8.23; 95% CI, 3.12-19.20; P < .001), lower body mass index (BMI) (kg•m −2 , OR, 0.94; 95% CI, 0.90-0.98; P = .005), and longer surgery duration (minutes, OR, 1.02; 95% CI, 1.01-1.03; P = .006). Previous cesarean delivery was the most significant risk factor, contributing to 9.6% of the total 17% variance predicted by all predictors examined. CONCLUSIONS: Spinal anesthesia failed to provide a pain-free surgery in 4.1% of our cesarean deliveries. Previous cesarean delivery was the most important predictor of spinal failure. Other important predictors included tubal ligation, lower BMI, and longer surgery duration. (Anesth Analg 2024;138:430-7) KEY POINTS• Question: What is the incidence of failed spinal anesthesia for cesarean deliveries at a tertiary care obstetric hospital, and what are the most important predictors for failure? • Findings: Spinal anesthesia failed to provide a pain-free surgery in 4.1% of our cesarean deliveries, and the most important predictors were previous cesarean delivery, tubal ligation, lower body mass index (BMI), and longer surgery duration. • Meaning: Inadequate spinal anesthesia for cesarean delivery is not uncommon, with a history of previous cesarean delivery as its most significant predictor.

show abstract

The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery

Cited by 13 publications

References 20 publications

Neuraxial anesthesia for postpartum tubal ligation at an academic medical center

Neuraxial anesthesia for postpartum tubal ligation at an academic medical center

Spinal Anaesthesia Failure Risk Followed by Failed Epidural Block in Caesarean Deliveries

The Incidence and Predictors of Failed Spinal Anesthesia After Intrathecal Injection of Local Anesthetic for Cesarean Delivery: A Single-Center, 9-Year Retrospective Review

Contact Info

Product

Resources

About