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Obstetric analgesia
Conversion to general anesthesia and intravenous supplementation during intrapartum cesarean delivery with an indwelling epidural catheter: a retrospective study
  1. Michael Yohay Stav1,2,
  2. Shai Fein1,2,
  3. Yuri Matatov1,2,
  4. Dana Hoffman1,2,
  5. Philip Heesen3,
  6. Yair Binyamin4,
  7. Daniel Iluz-Freundlich1,2,
  8. Leonid Eidelman2,5 and
  9. Sharon Orbach-Zinger1,2
  1. 1Department of Anesthesia, Rabin Medical Center Beilinson Hospital, Petah Tikva, Central, Israel
  2. 2Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  3. 3University of Zurich, Zurich, Switzerland
  4. 4Department of Anesthesiology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  5. 5Department of Anaesthesia, Assuta Ashdod Hospital, Ashdod, Israel
  1. Correspondence to Dr Michael Yohay Stav, Department of Anesthesia, Rabin Medical Center Beilinson Hospital, Petah Tikva 4941492, Israel; michaelstav.md{at}gmail.com

Abstract

Background Intraoperative pain during cesarean delivery with or without conversion to general anesthesia has been shown to negatively impact maternal and perinatal morbidity. Efforts to reduce these adverse events are a recent focus of obstetric anesthesia care. We aimed to assess rates of and risk factors for conversion to general anesthesia and intraoperative pain during intrapartum cesarean delivery with an indwelling epidural catheter in our academic center.

Methods In this retrospective cohort study, all women undergoing cesarean delivery with an indwelling epidural catheter between January 2017 and June 2022 were included. Labor epidural analgesia was provided according to a standardized protocol, and conversion to epidural anesthesia was achieved in the operating room before surgery. We determined the conversion rate to general anesthesia and associated risk factors. Second, we examined the rate of administration of analgesics/sedatives and related risk factors in cesarean cases that were not converted to general anesthesia.

Results Among the 1192 women undergoing intrapartum cesarean delivery with epidural anesthesia, there were 97 cases with conversion to general anesthesia (8.1%), of which 87 (89.7%) were due to a failed epidural. Higher age, higher weight, and higher gestational age were associated with decreased odds of conversion to general anesthesia. Higher gravidity and longer surgical time were associated with increased odds. An emergent indication was not associated with conversion to general anesthesia. Intravenous analgesic/sedative supplementation occurred in 141 cases (12.9%). Higher age was associated with decreased odds of supplementation, and longer surgical time was associated with increased odds.

Conclusion In our tertiary academic center, the rate of intraoperative conversion to general anesthesia and administration of analgesic/sedative medication among women undergoing intrapartum cesarean delivery with epidural anesthesia was relatively high. Emergency cesarean delivery was not associated with either of the above endpoints.

  • analgesia
  • Obstetrics
  • Pain Management

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/rapm-2024-105388

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @philipheesen, @BinyaminYair

    • MYS and SF contributed equally.

    • Presented at Parts of this article were presented in an abstract form at the ESA 2023 held in Glasgow, Scotland.

    • Contributors Study conception and/or design: SO-Z, MYS, SF and LE. Data collection: MYS, YM and DH. Statistical analysis: DI-F and PH. Writing of the draft: MYS and SO-Z. Interpretation of the data and/or revising the draft critically for important intellectual content: SO-Z, MYS, SF, LE and YB. Guarantor: MYS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.