Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study

Visser, W.; Dijkstra, Annemieke; Albayrak, Mustafa; Gielen, M.J.M.; Boersma, Eric; Vonsée, H.J.

doi:10.1007/s12630-009-9113-y

Cited by 21 publications

(18 citation statements)

References 26 publications

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“…In contrast, the GA conversion rate and complications of SA after ELA without attempting to perform ESA were comparable to cases only using SA without ELA [7]. In addition, SA after ELA may be preferred given its rapid induction and adequate muscle relaxation [8].…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…3,7,8 However, SA following EA might result in an unexpected high-level blockade or even total SA, 4,5 although there is no statistical difference compared to SA only. 6 There has been no study investigating the advantages of either spinal or epidural neuraxial anesthesia for parturients with epidural labor analgesia who failed to deliver vaginally. In our hospital, SA is frequently chosen for scheduled or emergency CS in order to circumvent the higher failure rate of EA, even if there is an epidural catheter in situ.…”

Section: Introductionmentioning

confidence: 99%

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

Huang

Hsieh

Wei

et al. 2015

Acta Anaesthesiologica Taiwanica

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“…The validity of this practice was confirmed by the largest series to examine spinal anesthesia after epidural analgesia. 4 There was no difference in the incidence of high spinal or total spinal anesthesia. There also was no difference in the incidence of hypotension or in Apgar scores.…”

Section: Commentmentioning

confidence: 88%

Distribution of Epidural Saline Upon Injection and the Epidural Volume Effect in Pregnant Women

Higuchi

Takagi

Onuki

et al. 2012

Survey of Anesthesiology

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S olution injected into the epidural space spreads freely, but not necessarily uniformly. In pregnant women, the dural sac is narrowed, and this narrowing may facilitate the spread of neuraxial block. The distribution of injected epidural solution may differ in pregnant and nonpregnant women. This study investigated the distribution of epidural saline injection and the extent of cerebrospinal fluid (CSF) reduction in pregnant women.Eight healthy women with a full-term singleton pregnancy and 8 nonpregnant nulliparous volunteers were studied. A day before exogenous oxytocin administration to augment labor, an epidural puncture was done at the L3-L4 level using loss-ofresistance technique with saline, without injecting more than 1 mL saline. An epidural catheter was advanced 3 to 5 cm into the epidural space. Low thoracic and lumbosacral axial magnetic resonance (MR) imaging was performed to measure CSF volume after catheter insertion. Sagittal MR images of the lower thoracic lumbosacral column were obtained to determine the level of the disk between T11 and 12 vertebrae. Low thoracic, lumbar, and spinal axial MR images caudal from this site were obtained at 8-mm increments. After the images were obtained, 10 mL saline was injected into the epidural space, and immediately thereafter, MR images were obtained in the same order as before the epidural saline injection. Cerebrospinal fluid volumes before and after epidural saline injection were compared. Dural sac coating was based on the observation of epidural saline in the anterior epidural space after injection in axial MR images at the pedicle levels from T12 to L5. Saline leakage from the foramina was determined using the same procedure at 6 disk levels from T11YT12 to L4YL5. Leakage of saline from the foramina was determined by counting the foramina that had saline on either side of the criteria line, defined as a straight line passing through the center of the intervertebral joint and the point of contact with the vertebral body at the disk level.Compared with nonpregnant women, the anterior and lateral epidural venous plexuses in the pregnant women were enlarged in association with dural sac narrowing, with the result that CSF volume before saline injection in the pregnant women was notably less than that in the nonpregnant women (42.0 T 4.2 and 33.6 T 6.5 mL, respectively; P G 0.05). In nonpregnant women, saline spread freely through the epidural space and coated the cylindrical dural sac with partial leaking through the foramina with no pattern. In pregnant women, saline did not leak through the intervertebral foramina, and the enlarged epidural venous plexus interfered with the dural sac coating, leading to only posterior accumulation of saline at the level of the pedicles of the vertebral bodies. Dural sac coating was not seen in any of the images from the pregnant women and in 3 of those from nonpregnant women. Saline leakage from the foramina was seen in images from 6 nonpregnant women and in none of the pregnant women. Mean CSF volume decreased in both g...

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Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study

Cited by 21 publications

References 26 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

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

Distribution of Epidural Saline Upon Injection and the Epidural Volume Effect in Pregnant Women

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