A comparison of spinal and epidural anesthesia for cesarean section following epidural labor analgesia: A retrospective cohort study

Huang, Chia-Hsiang; Hsieh, Yi-Jer; Wei, Ko-Hsin; Sun, Wei‐Zen; Tsao, Shao‐Lun

doi:10.1016/j.aat.2015.01.003

Cited by 28 publications

(26 citation statements)

References 20 publications

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“…The GA conversion rate for ESA after ELA in a retrospective cohort study by Huang et al [8] was much higher than that of our study (10.2% vs. 2.5%). The higher failure rate of ESA in Huang et al's study may be related to the higher degree of emergency and the absence of lipophilic opioids and epinephrine in the epidural solution [1314].…”

Section: Discussioncontrasting

confidence: 86%

“…The conversion rates to GA from SA after ELA were 3.9% and 13.7% in the studies by Visser et al [7] and Huang et al [8], respectively, which were both higher than that of this study (1.3%). The higher rates in the two studies could be related to the absence of lipophilic opioid and the higher degree of urgency even though the study by Huang et al did not address the detailed indications for GA use [11617].…”

Section: Discussioncontrasting

confidence: 77%

“…We only found two studies that compared SA and ESA following ELA for emergency CS. These were retrospective cohort studies by Visser et al [7] and Huang et al [8]. …”

Section: Discussionmentioning

confidence: 99%

“…In addition, SA after ELA may be preferred given its rapid induction and adequate muscle relaxation [8]. However, previous studies that compared the rates of failure and side effects between ESA and SA after ELA were retrospective cohort studies.…”

Section: Introductionmentioning

confidence: 99%

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

Yoon

Hwan

Yun

2017

Korean J Anesthesiol

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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.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussioncontrasting

confidence: 77%

“…We only found two studies that compared SA and ESA following ELA for emergency CS. These were retrospective cohort studies by Visser et al [7] and Huang et al [8]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Yoon

Hwan

Yun

2017

Korean J Anesthesiol

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“…Maternal satisfaction rates have been reported to range from 70% to 90% throughout the world, which is in accordance with the present study (8)(9)(10)(11)(12).…”

Section: Discussionsupporting

confidence: 82%

Maternal Satisfaction of Spinal Anesthesia for Elective Cesarean Section in an Academic Hospital

Sadeghi¹,

Bayat²,

Azimaraghi³

et al. 2017

Ann Anesth Crit Care

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Background: Currently, spinal anesthesia is an acceptable method for cesarean section (CS) throughout the world, since general anesthesia is associated with higher maternal morbidity and mortality rates. The current study was performed to survey different factors for maternal satisfaction of spinal anesthesia. Methods: This cross sectional study was performed on women who were candidates for elective CS at Dr. Shariati hospital. Informed consents were obtained from all the patients, and the risks and side effects of both spinal and general anesthesia were explained preoperatively. The mothers were free to choose the anesthetic technique. One day after the operation, all mothers were examined with respect to the variables.

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Median effective dose of spinal ropivacaine in combined spinal and epidural anesthesia for emergency cesarean delivery following failed vaginal delivery with epidural labor analgesia: a single-blind, sequential dose-finding study

Wei,

Ye,

et al. 2024

J Anesth

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Purpose This study aimed to estimate the median effective dose of intrathecal isobaric ropivacaine without opioid required for adequate cesarean delivery anesthesia after epidural labor analgesia. Methods Patients aged 20–40 years with American Society of Anesthesiology scores of I–II, body mass index ≤ 36, who underwent emergency cesarean delivery after failed vaginal delivery with epidural analgesia of a duration ≤ 6 h were included in the study. After removal of the epidural used for labor analgesia, a new combined spinal epidural was performed, and a dose of intrathecal isobaric ropivacaine without opioid was administered. The dose was determined using up–down methodology, with the starting patient's dose set to 12 mg. Adequate anesthesia, defined as a pinprick level no lower than T6 at 5 min after ropivacaine administration, resulted in the next patient receiving a dose of ropivacaine 1 mg higher, and inadequate anesthesia 1 mg lower. The primary outcome was the median (95% confidence interval (CI)) dose of spinal ropivacaine required for adequate cesarean delivery anesthesia. Results Of the 46 patients included in the study, 40 were analyzed. The median spinal ropivacaine dose was 8.11 mg (95% CI 7.29–8.93 mg) by the Dixon and Mood method and 8.06 mg (95% CI 6.93–9.00 mg) by isotonic regression. Two patients had high spinal anesthesia. Conclusion Our findings suggest that for 50% of patients undergoing cesarean delivery after failed vaginal delivery with epidural analgesia, an 8-mg spinal dose of isobaric ropivacaine without opioid provides an anesthesia level no lower than T6 at 5 min.

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A comparison of spinal and epidural anesthesia for cesarean section following epidural labor analgesia: A retrospective cohort study

Abstract: For parturients with labor epidural analgesia needing CS, the use of SA led to shorter anesthetic time and lower postoperative pain scores, with lower morphine doses compared with EA. However, the high failure rate with both neuraxial techniques needs to be addressed.

Cited by 28 publications

References 20 publications

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

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

Maternal Satisfaction of Spinal Anesthesia for Elective Cesarean Section in an Academic Hospital

Median effective dose of spinal ropivacaine in combined spinal and epidural anesthesia for emergency cesarean delivery following failed vaginal delivery with epidural labor analgesia: a single-blind, sequential dose-finding study

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