Failure of Augmentation of Labor Epidural Analgesia for Intrapartum Cesarean Delivery: A Retrospective Review

In Brief In this study, we aimed to identify the incidence and predictive factors associated with failed labor epidural augmentation for cesarean delivery. Data of parturients, who had received neuraxial labor analgesia and who subsequently required intrapartum cesarean delivery during an 18-mo period, were retrospectively studied. Predictors associated with failure of extension of epidural analgesia in the presence of adequate time for onset of epidural anesthesia were identified by univariate logistic regression. Of the 1025 parturients, 1.7% had failed epidural extension. Predictors of failed epidural anesthesia included initiation of labor analgesia with plain epidural technique (compared to combined spinal-epidural) (P = 0.001), ≥2 episodes of breakthrough pain during labor (P < 0.001) and prolonged duration of neuraxial labor analgesia (P = 0.02). IMPLICATIONS: A retrospective review of 1025 parturients with neuraxial labor analgesia who required intrapartum cesarean delivery, identified initiation of analgesia with an epidural technique (compared to a combined spinal-epidural technique), more than one episode of breakthrough pain during labor and prolonged duration of neuraxial labor analgesia to be associated with failed conversion to epidural anesthesia for cesarean delivery.