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ESRA19-0621 Incidence of failed epidural anaesthesia for emergency cesarean section and conversion rate to spinal or general anaesthesia
  1. V Singh,
  2. S Lal,
  3. J Thomas and
  4. N Narayanan
  1. Our Lady of Lourdes Hospital, Department of Anaesthesia and Critical Care, Drogheda, Ireland


Background and aims Recent advances in labour analgesia reflects quality of care. It is not just a focus on pain relief but an overall quality of the journey of labour. the overall incidence of epidural failure is reported as 23% in a teaching institution but Royal College of Anaesthetists suggests that the incidence of general anaesthesia (GA) in a parturient with a labour epidural analgesia should not more than 3%.

The objective of this study is to find out the number of patients on epidural analgesia requiring conversion of epidural anaesthesia to spinal or GA for emergency cesarean sections.

Methods Study will be conducted at Our Lady of Lourdes Hospital, Drogheda, over 2 months after the approval of audit with local committee. All patients coming for emergency C section (not Category 1) on epidural analgesia were included. We reviewed retrospective data collected from 08 May 2018 to 07 May 2019.

Results Total number of cases came to operating theatre with epidural in situ for Caesarean section was 229, out of which 18 cases converted into GA and 3 cases into spinal anaesthesia. Various factors noted for failure, two of them are inadequate epidural analgesia in labour ward and clinician top up with different volume and drug used.

Conclusions In our audit, we found 7.8% incidence of conversion in GA in a parturient with epidural in situ, which is high as compared to Royal College of Anaesthetists guideline. Uniformity among the clinician top-up and early recognition of inadequate epidural analgesia in labour ward which needed to be rectify.

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