Continuous Spinal Analgesia for Labor and Delivery

Tao, Weike; Grant, Erica N.; Craig, Margaret G.; McIntire, Donald D.; Leveno, Kenneth J.

doi:10.1213/ane.0000000000000903

Cited by 34 publications

(11 citation statements)

References 11 publications

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“…There was no difference in the rate of maternal fever between women with continuous spinal compared to epidural labor analgesia in our study cohort. While the incidence of maternal fever has not previously been compared between women with continuous spinal and epidural labor analgesia, the incidence of maternal fever in our study is similar to the 14.1% rate reported in an observational study of spinal analgesia provided with 23-gauge intrathecal catheters, 19 and to fever rates in patients with epidural catheters. 20 Our study is unique in that we were able to directly compare the rate of maternal fever between women receiving spinal and epidural labor analgesia.…”

Section: Discussionsupporting

confidence: 87%

Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study

Seiler¹,

Scavone

Shahul³

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Neuraxial labor analgesia is associated with elevations in maternal temperature; the mechanism responsible is unknown. Proposed mechanisms have included infection, altered thermoregulation, and inflammation, potentially triggered by local anesthetics. Studies of the association between neuraxial labor analgesia and maternal fever have focused on epidural analgesia, and there have been no comparisons of the rate of maternal fever between continuous spinal and epidural labor analgesia. METHODS: We performed a retrospective study to compare the rate of maternal fever between patients who received continuous spinal versus epidural labor analgesia between June 2012 and March 2020. Each patient who received continuous spinal analgesia was matched to 2 patients who received epidural analgesia and had the same nulliparous status. The primary outcome of our study was the incidence of intrapartum maternal fever, which we defined as any temperature ≥38 °C before delivery and compared between the continuous spinal and epidural groups using Fisher exact test. RESULTS: We identified 81 patients who received continuous spinal analgesia and 162 matched controls who received epidural analgesia. Demographic and obstetric characteristics of the patients were similar between groups. While the duration of analgesia did not significantly differ, there was markedly increased bupivacaine consumption in women with epidural analgesia. Eight of 81 (9.9%; 95% confidence interval [CI], 5.1-18.3) women with continuous spinal analgesia developed an intrapartum fever compared to 18 of 162 (11.1%; 95% CI, 7.1-16.9) of women with epidural analgesia (P = .83; Fisher exact test). CONCLUSIONS: There was no significant difference in the rate of maternal fever between women with continuous spinal compared to epidural labor analgesia. While the route of administration and dose of bupivacaine differs between epidural and spinal labor analgesia, they are titrated to produce similar levels of neuraxial blockade. Our results are consistent with a model in which epidural related maternal fever is due to altered thermoregulation from a central neuraxial block and argue against a direct effect of bupivacaine or fentanyl, although we cannot rule out a concentration-independent effect of bupivacaine or fentanyl or an inflammatory effect of the catheter itself. These retrospective results highlight the importance of prospective and mechanistic study of neuraxial analgesia-related maternal fever.

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Section: Discussionsupporting

confidence: 87%

Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study

Seiler¹,

Scavone

Shahul³

et al. 2022

Anesthesia &Amp; Analgesia

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“…A high rate of PDPH (28%) was also reported, but the rate of epidural blood patch placement was low (6% overall). Much better success was reported by Tao et al using the same system as Alonso, with no reported failures, no reported neurological deficits, and an incidence of PDPH similar to that reported by Arkoosh et al (8.8%) ( 12 ).…”

Section: Historical Perspectivessupporting

confidence: 64%

“…For labor analgesia, bolus doses 10% of epidural dosing and epidural continuous infusion have been suggested by some ( 23 ), but many authors have found that larger doses are required. A 2 ml/h infusion of a commonly used mixture of local anesthetic and fentanyl for epidural infusion (0.1% ropivacaine + fentanyl 2 µg/ml or 0.0625% bupivacaine + fentanyl 2 µg/ml) is a recommended starting regimen ( 12 , 24 ). Since standard epidural catheters can have up to 1 ml of dead space, a priming volume equal to the catheter volume will be required during the initial dose.…”

Section: Historical Perspectivesmentioning

confidence: 99%

Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia

et al. 2017

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The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques.

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“…used a mean (SD) dose of 8.2 (3.6) mg bupivacaine using continuous spinal anaesthesia in an observational study of 92 patients undergoing caesarean section . Continuous intrathecal infusions for labour or caesarean section have been used, where bupivacaine 0.5% is given to a maximum of 25 mg with adjuvant fentanyl . Intrathecal catheters may be ideal therefore for patients with suspected local anaesthetic resistance, allowing repeat doses if the initial dose proves inadequate or of short duration.…”

Section: Discussionmentioning

confidence: 99%

Local anaesthetic resistance in a patient with Ehlers‐Danlos syndrome undergoing caesarean section with continuous spinal anaesthesia

Włoch

Simpson

Gowrie‐Mohan

2020

Anaesthesia Reports

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A patient with a diagnosis of Ehlers-Danlos syndrome was scheduled to undergo elective caesarean section with a combined spinal-epidural anaesthetic technique. The epidural attempt resulted in an inadvertent dural puncture, and we decided subsequently to place an intrathecal catheter. She required high repeated doses of hyperbaric bupivacaine (32.5 mg over 1 h) through the catheter to establish adequate sensory blockade, together with supplemental analgesic techniques. Soon after the procedure, she recovered motor function rapidly and required further supplemental analgesia. We believe this is the first report of possible local anaesthetic resistance with an intrathecal catheter anaesthetic technique for a patient with Ehlers-Danlos syndrome. If there is resistance to the first dose of intrathecal local anaesthetic, a general anaesthetic may be the best option for such patients.

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Continuous Spinal Analgesia for Labor and Delivery

Cited by 34 publications

References 11 publications

Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study

Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study

Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia

Local anaesthetic resistance in a patient with Ehlers‐Danlos syndrome undergoing caesarean section with continuous spinal anaesthesia

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