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‘How much is too much?’: Spinal bupivacaine for intrapartum cesarean delivery following failed labor epidural – A retrospective cohort analysis
Abstract Number: T2D-309
Abstract Type: Original Research
Introduction: Conversion of epidural labor analgesia (ELA) to surgical anesthesia can be inadequate. CSE and Spinal anesthesia (SA) are viable options to avoid the complications of GA. Certain circumstances arise when the parturient cannot receive CSE such as severe platelet abnormality, inability to thread the catheter during CSE placement and urgent C/S; in these instances, SA can be employed. However, controversy exists about the dose of LA and the side effects including high/complete spinal and failed blocks. There is a paucity of large cohort study in this area. We conduct a retrospective cohort analysis in our university teaching hospital with over 12,000 annual deliveries to evaluate the incidence of high and failed spinal and describe our experience using a narrow range of LA dose.
Methods: After IRB approval, we retrospectively collected data from medical records of parturients who received SA or CSE for intrapartum C/S following failed ELA between 2012-2016. We have 500 eligible subjects who meet our inclusion criteria of failed ELA with 0.125% bupivacaine and fentanyl 2 mcg/ml at continuous infusion rate of 8-12mls/hr and received hyperbaric 0.75% bupivacaine for C/S.
Results: Preliminary analysis of 100 subjects out of 500 eligible cases indicate mean (+/-SD): Age (years) 26.7 (+/-6.93), Height (cm) 158.1 (+/- 5.64), BMI (kg/m2) 33.63 (+/- 6.8), Epidural infusion time: 9.1 (+/- 5.36) hours, Labor epidural sensory level pre SA(Median, range): T8 (T2-T12), Spinal/CSE sensory level (median, range): T4, (C8-T6), 0.75% Hyperbaric Bupivacaine Dose HBD (median, range) 10.5, 7.5-15 mg, Fentanyl (mcg) (median, range): 20, (15-20), Percent requiring phenylephrine 40%, Percent requiring ephedrine: 24%, Umbilical Artery pH (median, range): 7.23 (6.93-7.34). One patient (1%) had a high spinal and required assisted ventilation (SA HBD 10.5mg). 3% subjects had failed blocks, 2 received CSE with HBD 7.5mg and 1 had SA with HBD 10.5mg. HBD of 10.5mg was given to 30% of subjects and 74% of subjects received 10.5mg or greater.
Discussion: Preliminary analysis indicate that spinal anesthesia should be considered and dosed adequately in intrapartum C/S particularly in circumstances when a CSE cannot be placed.