The Incidence and Predictors of Failed Spinal Anesthesia After Intrathecal Injection of Local Anesthetic for Cesarean Delivery: A Single-Center, 9-Year Retrospective Review
Authors' conclusion
Spinal anesthesia failed to provide a pain-free surgery in 4.1% of our cesarean deliveries. Previous cesarean delivery was the most important predictor of spinal failure. Other important predictors included tubal ligation, lower BMI, and longer surgery duration.
Study context
- Population
- Women undergoing cesarean delivery under spinal anesthesia at a tertiary care obstetric hospital, 2010–2019
- Participants
- 5,361 cesarean deliveries
- Outcome
- Incidence of failed spinal anesthesia for cesarean delivery
Methodological detailssingle-centre, multivariable analysis, dominance analysis
- Single-centre
- Multivariable analysis
- Dominance analysis
Main finding
As reported in the abstract
Failed spinal anesthesia requiring an alternative anesthetic
Failed spinal anesthesia requiring an alternative anesthetic
2.1%
Conversion to GA
0.7%
Supplemental analgesia or sedation (additional)
2.0%
Spinal anesthesia failed to provide a pain-free surgery
4.1%
Observational data: associations, not effects.
Secondary outcomes
Predictors of failed spinal anesthesia (multivariable analysis)
| OR (95% CI) | P value | ||
|---|---|---|---|
| Previous cesarean delivery | 11.33 (7.09–18.20) | P < 0.001 | |
| Concomitant tubal ligation | 8.23 (3.12–19.20) | P < 0.001 | |
| Lower BMI (kg·m −2) | 0.94 (0.90–0.98) | P = 0.005 | |
| Longer surgery duration (minutes) | 1.02 (1.01–1.03) | P = 0.006 | |
| 0.050.21520Odds ratio (log scale) |
- Previous cesarean delivery contributed to 9.6% of the total 17% variance predicted by all predictors (dominance analysis)
Original publication
The Incidence and Predictors of Failed Spinal Anesthesia After Intrathecal Injection of Local Anesthetic for Cesarean Delivery: A Single-Center, 9-Year Retrospective Review. Anesth Analg. Published 4 April 2023. doi:10.
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