Among 3,239 women receiving spinal anesthesia for cesarean delivery, the failure rate was 9.1%, with use of the L4/L5 interspace increasing the risk of failure (adjusted RR 1.7; 95% CI 1.4-2.0).
Observational (n=3,239)
No
What is the incidence and what are the risk factors for failed spinal anesthesia during cesarean delivery?
The incidence of failed spinal anesthesia for cesarean delivery in this setting was high (9.1%), driven by multiple puncture attempts, lower interspace use, and provider experience.
Relative Risk: 1.7 (95% CI 1.4–2)
BACKGROUND: In a retrospective survey, we found 1% cases with complete and partial failure of spinal anesthesia for cesarean delivery between 2008 and 2010, which we attributed to underreporting because of the study design. In this prospective study, we determined the incidence of failed spinal anesthesia and identified the factors that increased its risk. METHODS: This prospective, observational study consisted of all spinal anesthetics administered for cesarean delivery surgery from January 2011 to December 2013. Our definition of failure covered complete (preoperative) failure to achieve a pain-free operative condition and pain during surgery (intraoperative failure). RESULTS: Of a total of 3568 cesarean deliveries, there were 3239 (90.8%) spinal blocks, and the overall failure was 294 (9.1%). These were rescued by conversion to general anesthesia (22.8%) and repeating spinal (23.1%) and IV analgesic supplementation (54.1%). Analysis by logistic regression model indicated that factors associated with failure were the level of experience of the anesthesia provider as shown by senior registrar (adjusted risk ratio RR, 1.4; 95% confidence interval CI, 1.0-1.9), >1 lumbar puncture attempt (adjusted RR, 1.5; 95% CI, 1.1-1.9), and use of the L4/L5 interspace (adjusted RR, 1.7; 95% CI, 1.4-2.0). CONCLUSIONS: The rate of failed spinal anesthesia from this study was high. The independent predictors of failure were multiple lumbar puncture attempts, use of the L4/L5 interspace, and the level of experience of the anesthesia provider. It is imperative to develop clear guidelines to standardize our obstetric spinal anesthetic practice as well as the management of failures.
Rukewe et al. (2015) conducted an observational in Cesarean delivery (n=3,239). Multiple lumbar puncture attempts, use of L4/L5 interspace, and senior registrar experience vs. Fewer attempts, other interspaces, and different provider experience levels was evaluated on Failed spinal anesthesia (complete preoperative failure or intraoperative pain) (adjusted RR 1.7, 95% CI 1.4-2.0). Among 3,239 women receiving spinal anesthesia for cesarean delivery, the failure rate was 9.1%, with use of the L4/L5 interspace increasing the risk of failure (adjusted RR 1.7; 95% CI 1.4-2.0).