Safety of spinal anesthesia after failed epidural in the parturient

R. J. Lowes, R. R. Gaiser, T. G. Cheek

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The safety of spinal anesthesia after failed epidural in the parturient has been debated following reports of high sensory and motor blockade requiring intubation'"-3 We retrospectively examined our cases of spinal anesthesia after failed epidural to determine whether sensory levels were higher than after spinal anesthesia alone. Methods: After approval by the HUP Institutional Review Board all obstetric anesthesia records were reviewed for the period of January 1990 through December 1994. Cases of inadequate epidural anesthesia, with documented unilateral or bilateral sensory changes, followed by spinai anesthesia were selected. Variabies examined were : procedure, spinal anesthetic type and dose, level of subarachnoid injection, patients' height and weight, total doses of vasopressors used, and level of sensory blockade after subarachnoid injection. Control cases, having a primary spinal anesthetic, were then matched for records containing all the required data. Spread of anesthesia was defined as the difference in level between the highest documented derrnatomal sensory change and the level of subarachnoid injection. Data analysis utilized the Mann-Whitney rank sum test and pooled variance t test. P < 0.05 was considered significant. Results: Twenty-four records containing spinal after tailed epidural were identified Nine of these were complete. Eight matched pairs underwent cesarean section and one pair vaginal delivery. Statistical analysis revealed nonsignificant differences for all parameters evaluated. Epidural/Spinal Control Height (cm) 164.0+/-8.7 162.9 +/- 8.6 Weight (kg) 93.1 +/- 2 i.4 77 2 W- 18.6 Dose (ing Bupivicaine) 13.2 +/- 1.9 13.3 W-1.6 Dermatome Spread 14 14 Ephedrine (mg) 22.2 t-/- 19.5 35.0 +/- 30.4 No (0/24) patients with spinal after inadequate epidural required intubation or assisted ventilation. Two (2/24) patients were found to have sensory levels changes to the cervical dermatomes. Four (4/9) of the control patients were treated with phenylephrine for hypotension versus none (0/9) of the matched epidural/spinal patients Discussion: Spinal anesthesia after inadequate epidural is a safe and effective technique. Although the difference in dcrmatomc spread was not statistically significant there were two (2/24) patients in the epidural group with sensory changes to the cervical level (C6 and C8). It is particularly relevant that all ( 24/24) patients with inital incomplete epidural blockade received adequate anesthesia with no intra-operative adverse outcome. Although not contraindicated, we continue to believe that spinal anesthesia after inadequate epidural warrants heightened vigilance. References:.

Original languageEnglish
Pages (from-to)2
Number of pages1
JournalRegional Anesthesia
Volume21
Issue number2 SUPPL.
StatePublished - 1996

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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