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Comparison of spinal anesthesia induction time among three neuraxial techniques for emergency cesarean delivery.
Abstract Number: T2I-42
Abstract Type: Original Research
Background: Although extension of epidural analgesia is a standard method for cesarean delivery (CD) following labor epidural analgesia, administration of subarachnoid block has been preferred in our institute due to its dense blockade. However, a spinal tap for women in whom an epidural catheter has already been placed for labor is sometimes difficult, which may result in conversion to general anesthesia. The aim of this study was to investigate the time needed for spinal tap in parturients with versus without labor epidural analgesia.
Method: The medical records of all emergent CDs over a 4-year period from 2014 to 2017 at a university hospital in Japan were retrospectively studied. Exclusion criteria included (1) patients who did not receive spinal anesthesia, (2) preterm parturients. The cases were divided into 3 groups according to the intraoperative analgesia technique: subarachnoid block group (SAB), supplementation of subarachnoid block following labour epidural analgesia group (LEA), and combined spinal and epidural block group (CSE). Patient characteristics and anesthesia induction time (IT) were recorded; the IT was defined as the time from arrival in the operating room to subarachnoid injection. For patients who received the second spinal tap due to insufficient analgesia by the first spinal block, the time to the second drug injection was recorded as the IT. For statistical analysis, ANOVA and Tukey-Kramer’s HSD post hoc test were used, and a p value <0.05 was considered statistically significant.
Results: A total of 469 emergent CDs were performed during this period. Among them, 231 preterm and 17 without intraoperative subarachnoid block patients were excluded from this study. Eighty-one, 58, and 82 cases were found in SAB, LEA, and CSE, respectively. Body mass index and ASA physical status did not differ among 3 groups, but maternal age in LEA was significantly older than in SAB (36.4 vs. 34.3 year; p=0.0289). The mean IT in CSE group was 21.8 minutes and significantly longest among the 3 groups. Between LEA and SAB, IT in LEA was significantly longer than that in SAB (16.9 vs. 13.3 minutes, p=0.0075).
Conclusion and discussion: The longest induction time in CSE can be explained as the additional time for the replacement of an epidural catheter. The different result between LEA and SAB may be due to the expanded spinal space after labor epidural analgesia, which may support our hypothesis that spinal tap following labor epidural can be sometimes difficult. Although maternal age in LEA was significantly older than in SAB, which might have associated with failed subarachnoid blockades, it has been reported that maternal age is not a risk factor for failure of spinal anesthesia in CDs. Therefore we also speculated that this difference of age does not have strong influence on IT. Further studies will be required to investigate the mechanism by image examinations such as lumber spinal ultrasonography.