Key result
Co-morbidity (OR 9.6), emergency procedure (OR 2.2), and other risk factors were significantly associated with failed spinal anesthesia, which occurred in 19.5% of parturients.
Why the study?
Spinal anesthesia has a failure risk of 1-17% during cesarean section, which may reduce maternal satisfaction and impact maternal and fetal outcomes, motivating an evaluation of its incidence and associated factors.
What is the incidence and what are the factors associated with failed spinal anesthesia during cesarean section in parturients?
Observational (n=275)
What is the incidence and what are the factors associated with failed spinal anesthesia during cesarean section in parturients?
The incidence of failed spinal anesthesia during cesarean section was high (19.5%), driven by factors such as emergency procedures, provider experience, and patient comorbidities.
High failed spinal incidence (19.5%) warrants targeted risk mitigation in this setting; leaves open need for interventional studies to confirm modifiable factors.
Background: Spinal anesthesia is the method of choice for cesarean section as it is associated with low occurrence of intra-operative and post-operative morbidities. Despite this significant move towards spinal anesthesia, it has a risk of failure reported in the range of 1–17%. Failed spinal is a disgusting event for the mother and the anesthetist that may lead to decreased maternal satisfaction and may potentially impact fetal and maternal outcomes. Objective: The study was designed to determine the incidence and factors associated with failed spinal anesthesia during cesarean section. Methods: A prospective institution based observational study was conducted on 275 parturients from October 1st to December 31st, 2019. After collection, the data was data entered and analyzed by SPSS version 21. The main outcome measure was the incidence of failed spinal anesthesia and the chi-square test was used to compare failure rates and multivariable regression analysis was performed to investigate potential factors. Results: The study involved 275 parturients and the overall incidence of failed spinal was 19.5%. Co-morbidity (OR = 9.615; CI = 1.255–7.368), emergency procedure (AOR = 2.191; CI = 1.087–4.417), needle size (2.3; CI = 0.92–0.615), anesthetist's experience (AOR = 4.23; CI = 2.14–8.34), surgeon's experience (AOR = 2.530; CI = 1.319–4.853), bloody CSF flow (AOR = 2.440; CI = 0.103–0.582), and volume of local anesthetics (AOR = 2.781; CI = 1.432–5.398) were significantly associated with failed spinal anesthesia. Conclusions and recommendations: The incidence of failed spinal anesthesia was found to be high compared to previous studies. Since the study tried to identify risk factors for failure, we should act accordingly to minimize the failure rate. Highlights:
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Ashagrie et al. (2020) conducted an observational in cesarean section (n=275). Risk factors for failed spinal anesthesia was evaluated on incidence of failed spinal anesthesia. Co-morbidity (OR 9.6), emergency procedure (OR 2.2), and other risk factors were significantly associated with failed spinal anesthesia, which occurred in 19.5% of parturients.
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