Incidence and Causes of Failed Spinal Anesthesia

Abstract

Introduction: Spinal anesthesia (SA) is one of the most frequently applied anesthesia procedures today. However, SA failure rate varies between 1 and 17%. The age of the patient, the position at which the procedure is performed, or the characteristics of the technical operation can affect success. In this study, we aimed to compare the most frequent SA failures according to the types of surgery and causes of failure. The results of SA procedures performed in a university hospital were compare to those published in the current literature. Materials and Methods: After obtaining ethics committee approval for our study, the hospital archives were examined retrospectively for 1 year with respect to SA procedures. SA application and failure rates were examined. Three or more SA attempts, failed dural puncture, or unsuccessful injection, and anesthesia applications that did not provide sufficient sensory block for surgery despite successful drug treatment were defined as failure. Results: Of all anesthesia procedures, SA was applied at a rate of 23.5%. Our SA failure rate was calculated as 16.6%. Considering a single surgical procedure, obstetric anesthesia was the most common surgery with failed SA (28.7%). The most common cause of failure was insufficient analgesia (32.9%). Discussion: SA failure rates were observed to be in a variable distribution range in the literature, and in some studies, SA failure was defined as a block that did not occur despite a full dose and successful injection, and this rate was found to be 3.9%. The high rate in our study group may be explained by differences in the definition of SA: blocks performed with several trials and any block that could not be applied were also recorded as SA failure. The reasons for failing to apply this procedure is an issue that is worth examining also in terms of patient satisfaction and safety, which is an important issue. Conclusion: Although the definition of unsuccessful SA is confusing, SA failure rates are worth examining and improving for each hospital.

Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study

“…Likewise, GA after a failed neuraxial block was shown to have more complications than either de novo GA or neuraxial anaesthesia alone 14 . A common cause of failure of neuraxial anaesthesia appears to be insufficient analgesia due to low volume of local anaesthetic and long surgery time 15,16 …”

“…14 A common cause of failure of neuraxial anaesthesia appears to be insufficient analgesia due to low volume of local anaesthetic and long surgery time. 15,16 Failure rates in different studies differ because of different anaesthesia regimens. A recent survey has shown large variation in dosage of local anaesthesia, addition of spinal opiates, and the way the block is tested.…”

Komplikasi Pasca Anestesia Spinal: Apa saja yang harus kita waspadai?

“…2 Tindakan in dipilih oleh anestesiologis dan pasien karena memiliki kelebihan dapat memberikan efek anestesi dan analgesia secara bersama-sama, mencegah komplikasi pernapasan serius dari anestesi umum, dan tingkat kepuasan pasien yang tinggi. 3 Meskipun umumnya dianggap aman, anestesia spinal tetap dapat menyebabkan beberapa komplikasi. Walaupun sebagian besar komplikasi anestesia spinal memiliki insiden yang rendah, kita tetap perlu waspada.…”

Repeat spinal or general anesthesia: A dilemma!

“…Such inadequacy may include one or more components of the block: the extent, quality, or duration. 2,3 This becomes more problematic if occurs during the conduct of surgery. In such circumstances, maintenance of anesthesia can be done by local anesthetic infiltration of the wound, various nerve block supplements, sedation, general anesthesia, or repeat subarachnoid block.…”

“…Available literature shows about 1% to 17% of spinal anesthesia fails to serve its purpose, but most of the studies reported a failure rate between 2% to 4%. 4 Spinal anesthesia is considered to have failed if block have not been achieved even after 10 minutes of heavy bupivacaine and 25 minutes for plain bupivacaine injection in the subarachnoid space. 5 Inadequate duration of spinal anesthesia may be due to various factors.…”