title: Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section.
abstract: OBJECTIVE
  To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS).
  
  
  METHODS
  For 6 months, we prospectively studied women undergoing a CS with a functioning epidural catheter in place from the delivery ward. All parturients received the same epidural protocol: bolus of bupivacaine 0.1% and fentanyl, then bupivacaine 0.1% and fentanyl (2 microg/ml) 10-15 ml/h and an additional 5 ml of bupivacaine 0.125% top-ups according to patient request. Sixteen millilitres of lidocaine 2%, 1 ml of bicarbonate, and 100 microg of fentanyl were given for CS. Failed epidural analgesia was defined as the need to convert to general anesthesia.
  
  
  RESULTS
  Of the 101 parturients studied, 20 (19.8%) required conversion to general anesthesia. In univariate analysis, the likelihood of failed epidural anesthesia was inversely correlated with parturient's age (P = 0.014) and directly correlated with pre-pregnancy weight (P = 0.019), weight at the end of pregnancy (P = 0.003), body mass index (BMI) at the end of pregnancy (P = 0.0004), gestational week (P = 0.008), number of top-ups (P = 0.0004) and visual analog scale (VAS) 2 h before CS (P = 0.03). In multivariate analysis, the number of top-ups in the delivery ward was the best predictor of epidural anesthesia failure (odds ratio 4.39, P = 0.005).
  
  
  CONCLUSIONS
  Younger, more obese parturients at a higher gestational week, requiring more top-ups during labor, having a higher VAS in the 2 h before CS are at risk of inability to extend labor epidural analgesia to epidural anesthesia for CS.
authors.affiliation: Department of Anesthesiology, Rabin Medical Center/Beilinson Campus, Sackler School for Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Orbach-Zinger
authors.forename: L
authors.initials: L
authors.lastname: Friedman
authors.forename: A
authors.initials: A
authors.lastname: Avramovich
authors.forename: N
authors.initials: N
authors.lastname: Ilgiaeva
authors.forename: R
authors.initials: R
authors.lastname: Orvieto
authors.forename: J
authors.initials: J
authors.lastname: Sulkes
authors.forename: L A
authors.initials: LA
authors.lastname: Eidelman
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000295:instrumentation; D000767:Anesthesia, Epidural / Q000295:instrumentation; D000773:Anesthesia, Obstetrical / Q000295:instrumentation; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure