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Need for additional anesthesia after single injection spinal analgesia for labor

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Authors: E. E. Sharpe et al
International Journal of Obstetric Anesthesia June 2019

Highlights

  • •The median reduction in pain score was 9 (0–10 scale) after labor spinal analgesia.
  • •Of 429 women receiving spinal analgesia, 14% later needed anesthesia.
  • •Primiparity, induction and lower cervical dilation increased risk of anesthesia.
  • •Two patients (0.5%) ultimately needed general anesthesia for cesarean delivery.

There is little information about the use and efficacy of single injection spinal blocks for labor analgesia; specifically, how frequently subsequent analgesia or anesthesia is needed. This study determined how frequently an additional anesthetic intervention was needed in women who received single injection spinal analgesia.

Methods

This retrospective study examined electronic medical records to find all single injection spinal analgesic blocks for labor analgesia over a 14-year (2003–2016) period. Patient and block characteristics and patient outcomes were recorded. The primary outcome was need for an additional anesthetic intervention following single injection spinal for labor analgesia.

Results

Four-hundred-and-twenty-eight patients received single injection spinal blocks for labor and 60 (14.0%) needed an additional anesthetic either for labor analgesia (n=49) or an unexpected procedure (n=11). Two of these (0.5%) required general anesthesia. Parity of zero (nulliparous), a low cervical dilation at the time of the spinal injection, and induction of labor status, were associated with an increased risk of needing an additional anesthetic intervention.

Conclusions

This retrospective review provides evidence that single injection spinal anesthesia may be used for multiparous women with spontaneous labor and more advanced cervical dilation.

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