Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section

S. Orbach-Zinger, L. Friedman, A. Avramovich, N. Ilgiaeva, R. Orvieto, J. Sulkes, L. A. Eidelman

Research output: Contribution to journalArticle

14 Citations (Scopus)

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 languageEnglish
Pages (from-to)793-797
Number of pages5
JournalActa Anaesthesiologica Scandinavica
Volume50
Issue number7
DOIs
StatePublished - Aug 1 2006
Externally publishedYes

Fingerprint

Epidural Analgesia
Epidural Anesthesia
Cesarean Section
Parturition
Bupivacaine
Fentanyl
Visual Analog Scale
Pregnancy
General Anesthesia
Weights and Measures
Bicarbonates
Lidocaine
Body Mass Index
Multivariate Analysis
Catheters
Anesthesia
Odds Ratio

Keywords

  • Cesarean section
  • Epidural analgesia
  • Epidural anesthesia
  • General anesthesia
  • Labor

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Orbach-Zinger, S., Friedman, L., Avramovich, A., Ilgiaeva, N., Orvieto, R., Sulkes, J., & Eidelman, L. A. (2006). Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. Acta Anaesthesiologica Scandinavica, 50(7), 793-797. https://doi.org/10.1111/j.1399-6576.2006.01083.x

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 journalArticle

Orbach-Zinger, S, Friedman, L, Avramovich, A, Ilgiaeva, N, Orvieto, R, Sulkes, J & Eidelman, LA 2006, 'Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section', Acta Anaesthesiologica Scandinavica, vol. 50, no. 7, pp. 793-797. https://doi.org/10.1111/j.1399-6576.2006.01083.x
Orbach-Zinger, S. ; Friedman, L. ; Avramovich, A. ; Ilgiaeva, N. ; Orvieto, R. ; Sulkes, J. ; Eidelman, L. A. / Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. In: Acta Anaesthesiologica Scandinavica. 2006 ; Vol. 50, No. 7. pp. 793-797.
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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.",
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AU - Eidelman, L. A.

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