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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

A Retrospective Chart Review: Repeat C-sections Performed using CSE and Intra-operative Use of the Epidural Catheter

Abstract Number: 91
Abstract Type: Original Research

Laura Chang MD1 ; Deborah Stein MD2; Liane Germond MD3

Repeat cesarean sections are associated with longer surgical time secondary to intra-abdominal adhesions as well as bladder injury. In addition, there is an increased risk of intra-operative bleeding and cesarean hysterectomies in certain patient populations. Single shot spinal anesthesia is used for C-sections for its simplicity of technique, rapidity in achievement of sensory and motor block and usefulness for surgical anesthesia. Our institution utilizes combined spinal-epidurals (CSE) for the duality of the benefits of a single shot spinal anesthesia combined with the security of an epidural catheter for re-bolusing purposes, especially in patients who require repeat c-section of higher order. The aim of this retrospective chart review was to assess 1. if CSE required more time for insertion in comparison to a single-shot spinal and 2. how frequently the epidural component of the CSE was utilized for third or higher order repeat c-sections. If the time for CSE was longer than that of single shot spinal and the epidural component was not used often, it may not be worth the extra time for its insertion and increased complications inherent to epidural placement.

We identified all c-sections performed with regional anesthesia, without a laboring epidural, from July 2009-December 2009 using a retrospective chart review. This group was divided into those that received a CSE or a single-shot spinal. The CSE group was further sub divided to reveal tertiary or greater c-sections. The time from entering the OR to the completion of each regional technique was noted and this time was called the "insertion time." The number of patients from the CSE group whose epidural catheter was used was measured as well as the duration of surgery.

Within our institution, there were 467 c-sections performed using a regional anesthesia technique over this six month period. 169 were performed using a CSE and 298 using a spinal anesthetic. Out of the 169 CSE cases, 50 were for third or higher repeat c-sections. The average time of all CSE insertions was 13 minutes and for the third or higher repeat c-sections was 12 minutes. The average single-shot spinal insertion time was 9 minutes. The epidural catheter was utilized for re-bolusing purposes in 24% of the total CSEs inserted. This rate increased to 32% for third or higher repeat c-sections. The average surgical time for all CSE patients was 65 minutes and for third or higher repeat c-sections was 77 minutes.

We acknowledge there are deficiencies in this review. There was no standard spinal dose for the CSE. It is unknown what prompted the use of the epidural catheter - evidence of pain sensation vs. preemptive use due to passage of time. Despite the shorter average time spent in implementing a spinal technique over a CSE and despite the shortcomings of this review, the relatively high use of these catheters may warrant us to continue our current practice of using CSE for tertiary or higher c sections.

SOAP 2010