Spinal anesthesia for cesarean section following inadequate labor epidural analgesia: a retrospective audit.
BACKGROUND
High blocks have been reported when spinal anesthesia is used for cesarean section following inadequate labor epidural analgesia. We have therefore modified the practice at our institution to minimize this risk and conducted a retrospective observational study of outcome following the change of practice.


METHODS
The records of 115 women with inadequate epidural labor analgesia who required cesarean section between July 1998 and January 2002 were studied. No epidural boluses were administered in the 30 min preceding spinal anesthesia and a reduced spinal dose, median (range) 9.38 mg (7.5-11.3 mg) of 0.75% hyperbaric bupivacaine and fentanyl 15 microg (10-25 microg) was used. Patients were left sitting for 2 min and then positioned supine with left uterine displacement and were closely monitored for symptoms or signs that would suggest a high block.


RESULTS
No parturient developed a high spinal necessitating intubation, and there was no adverse neonatal outcome.


CONCLUSIONS
These findings do not conclusively establish this method as safe, but should spinal anesthesia for cesarean section following suboptimal labor epidural analgesia be considered, avoiding epidural boluses immediately preceding spinal injection, using a lower spinal dose, and delayed supine positioning following spinal injection may be advisable.
Dadarkar
P
P
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9068, USA.
Philip
J
J
Weidner
C
C
Perez
B
B
Slaymaker
E
E
Tabaczewska
L
L
Wiley
J
J
Sharma
S
S
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D000775:Anesthesia, Spinal; D001034:Apgar Score; D002585:Cesarean Section; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy; D007231:Infant, Newborn; D010147:Pain Measurement; D011247:Pregnancy; D012189:Retrospective Studies; D017211:Treatment Failure; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004809:Ephedrine