Abstract
Aim: 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 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, followed by bupivacaine 0.1% and fentanyl (2 μg/ml) 10-15 ml/h and an additional 5 ml of bupivacaine 0.125% as top-up according to patient request. Sixteen milliliters 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 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 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) score 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 and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.
| Original language | English |
|---|---|
| Pages (from-to) | 793-797 |
| Number of pages | 5 |
| Journal | Acta Anaesthesiologica Scandinavica |
| Volume | 50 |
| Issue number | 7 |
| DOIs | |
| State | Published - Aug 1 2006 |
| Externally published | Yes |
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Keywords
- Cesarean section
- Epidural analgesia
- Epidural anesthesia
- General anesthesia
- Labor
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
Cite this
Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. / Orbach-Zinger, S.; Friedman, L.; Avramovich, A.; Ilgiaeva, N.; Orvieto, R.; Sulkes, J.; Eidelman, L. A.
In: Acta Anaesthesiologica Scandinavica, Vol. 50, No. 7, 01.08.2006, p. 793-797.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section
AU - Orbach-Zinger, S.
AU - Friedman, L.
AU - Avramovich, A.
AU - Ilgiaeva, N.
AU - Orvieto, R.
AU - Sulkes, J.
AU - Eidelman, L. A.
PY - 2006/8/1
Y1 - 2006/8/1
N2 - Aim: 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 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, followed by bupivacaine 0.1% and fentanyl (2 μg/ml) 10-15 ml/h and an additional 5 ml of bupivacaine 0.125% as top-up according to patient request. Sixteen milliliters 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 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 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) score 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 and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.
AB - Aim: 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 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, followed by bupivacaine 0.1% and fentanyl (2 μg/ml) 10-15 ml/h and an additional 5 ml of bupivacaine 0.125% as top-up according to patient request. Sixteen milliliters 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 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 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) score 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 and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.
KW - Cesarean section
KW - Epidural analgesia
KW - Epidural anesthesia
KW - General anesthesia
KW - Labor
UR - http://www.scopus.com/inward/record.url?scp=33745834414&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33745834414&partnerID=8YFLogxK
U2 - 10.1111/j.1399-6576.2006.01083.x
DO - 10.1111/j.1399-6576.2006.01083.x
M3 - Article
C2 - 16879460
AN - SCOPUS:33745834414
VL - 50
SP - 793
EP - 797
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 7
ER -