Anesth Pain Med.  2015 Jul;10(3):203-207. 10.17085/apm.2015.10.3.203.

Effectiveness of spinal anesthesia after epidural labor analgesia versus spinal anesthesia only for intrapartum cesarean section

• Jeon JY
• Do SH
• Lee IH
• Jee YS
• Park SI
• Yoon HJ

• KMID: 2148032
• DOI: http://doi.org/10.17085/apm.2015.10.3.203

Abstract

BACKGROUND
Spinal anesthesia (SA) after epidural labor analgesia (ELA) can have advantages over augmentation of ELA due to its rapid onset and high-quality analgesia. However, unexpected side effects and diverse failure rates have been reported in women that received SA after ELA. We prospectively compared the effectiveness and side effects of SA after ELA versus SA only for intrapartum cesarean section.
METHODS
The ELA/SA group received continuous epidural infusion at a rate of 10 ml/h for labor pain. In both groups, spinal anesthesia was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 microg of fentanyl using a pencil point needle. The rate of conversion to general anesthesia, the need for intraoperative analgesic supplements, and the incidence of high spinal block and hypotension were investigated.
RESULTS
The rate of conversion to general anesthesia was higher in the ELA/SA group compared with the SA group (15.2 vs. 2.7%). Eighty percent of the conversion cases in the ELA/SA group were converted due to lack of sensory block. The need for intraoperative analgesic supplements and the rates of high spinal block and hypotension were comparable in the two groups.
CONCLUSIONS
SA after ELA is associated with a high rate of conversion to general anesthesia during intrapartum cesarean section.

Keyword

Conversion to general anesthesia; Epidural analgesia; Failed spinal anesthesia; Intrapartum cesarean section

MeSH Terms

Analgesia*
Analgesia, Epidural
Anesthesia, General
Anesthesia, Spinal*
Bupivacaine
Cesarean Section*
Female
Fentanyl
Humans
Hypotension
Incidence
Labor Pain
Needles
Pregnancy
Prospective Studies
Bupivacaine
Fentanyl