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Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section
Author(s) -
OrbachZinger S.,
Friedman L.,
Avramovich A.,
Ilgiaeva N.,
Orvieto R.,
Sulkes J.,
Eidelman L. A.
Publication year - 2006
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2006.01095.x
Subject(s) - medicine , fentanyl , anesthesia , bupivacaine , lidocaine , pregnancy , bolus (digestion) , gestational age , gestation , visual analogue scale , body mass index , surgery , genetics , biology
Objective: To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS). Methods: For 6 months, we prospectively studied women undergoing a CS with a functioning epidural catheter in place from the delivery ward. All parturients received the same epidural protocol: bolus of bupivacaine 0.1% and fentanyl, then bupivacaine 0.1% and fentanyl (2 μg/ml) 10–15 ml/h and an additional 5 ml of bupivacaine 0.125% top‐ups according to patient request. Sixteen millilitres of lidocaine 2%, 1 ml of bicarbonate, and 100 μg of fentanyl were given for CS. Failed epidural analgesia was defined as the need to convert to general anesthesia. Results: Of the 101 parturients studied, 20 (19.8%) required conversion to general anesthesia. In univariate analysis, the likelihood of failed epidural anesthesia was inversely correlated with parturient’s age ( P = 0.014) and directly correlated with pre‐pregnancy weight ( P = 0.019), weight at the end of pregnancy ( P = 0.003), body mass index (BMI) at the end of pregnancy ( P = 0.0004), gestational week ( P = 0.008), number of top‐ups ( P = 0.0004) and visual analog scale (VAS) 2 h before CS ( P = 0.03). In multivariate analysis, the number of top‐ups in the delivery ward was the best predictor of epidural anesthesia failure (odds ratio 4.39, P = 0.005). Conclusion: Younger, more obese parturients at a higher gestational week, requiring more top‐ups during labor, having a higher VAS in the 2 h before CS are at risk of inability to extend labor epidural analgesia to epidural anesthesia for CS.