Conversion of epidural analgesia to anesthesia for cesarean section

Authors

  • Yevhenii Grizhimalsky Maternity hospital “Leleka”, Kyiv
  • Andrii Harha Maternity Hospital “Leleka”, Kyiv
  • Yevhenii Sulimenko Maternity Hospital “Leleka”, Kyiv

DOI:

https://doi.org/10.31636/pmjua.v6i1.1

Keywords:

cesarean section, epidural anaesthesia, labour pain relief, conversion

Abstract

The frequency of cesarean sections is increasing from year to year, and the choice of optimal anesthetic management is important. Regional anaesthesia is the anaesthesia of choice for the cesarean section because it reduces maternal and neonatal risks. If an epidural pain relief of labor is performed, then this epidural catheter can be successfully used for conversion to epidural anaesthesia. The choice of drug for conversion depends on the degree of urgency; the highest rate of onset of anesthesia is shown by lidocaine with adjuvants (fentanyl, sodium bicarbonate). Conversion failure occurs in 0–21% of cases; the main risk factors for conversion failure are inadequate epidural analgesia and patient height. The management of failed conversion depends on the category of urgency and other factors and may include spinal, combined spinal-epidural, or general anesthesia

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References

Maternity Services Monthly Statistics July 2020, experimental statistics Available from: https://digital.nhs.uk/data-and-information/publications/statistical/maternity-services-monthly-statistics/july-2020

Chestnut DH. Anesthesia and Maternal Mortality. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 1997 Feb 1;86(2):273–6. Available from: https://doi.org/10.1097/00000542-199702000-00001

Gupta S, Naithani U, Madhanmohan C, Singh A, Reddy P, Gupta A. Evaluation of decision-to-delivery interval in emergency cesarean section: A 1-year prospective audit in a tertiary care hospital. Journal of Anaesthesiology Clinical Pharmacology [Internet]. Medknow; 2017;33(1):64. Available from: https://doi.org/10.4103/0970-9185.202197

Desai N, Gardner A, Carvalho B. Labor Epidural Analgesia to Cesarean Section Anesthetic Conversion Failure: A National Survey. Anesthesiology Research and Practice [Internet]. Hindawi Limited; 2019 Jun 2;2019:1–7. Available from: https://doi.org/10.1155/2019/6381792

Hillyard SG, Bate TE, Corcoran TB, Paech MJ, O’Sullivan G. Extending epidural analgesia for emergency Caesarean section: a meta-analysis. British Journal of Anaesthesia [Internet]. Elsevier BV; 2011 Nov;107(5):668–78. Available from: https://doi.org/10.1093/bja/aer300

Gaiser RR, Cheek TG, Adams HK, Gutsche BB. Epidural lidocaine for cesarean delivery of the distressed fetus. International Journal of Obstetric Anesthesia [Internet]. Elsevier BV; 1998 Jan;7(1):27–31. Available from: https://doi.org/10.1016/s0959-289x(98)80025-3

Lam DTC, Ngan Kee WD, Khaw KS. Extension of epidural blockade in labour for emergency Caesarean section using 2% lidocaine with epinephrine and fentanyl, with or without alkalinisation*. Anaesthesia [Internet]. Wiley; 2001 Aug;56(8):777–98. Available from: https://doi.org/10.1046/j.1365-2044.2001.02058-4.x

Sharawi N, Bansal P, Williams M, Spencer H, Mhyre JM. Comparison of Chloroprocaine Versus Lidocaine With Epinephrine, Sodium Bicarbonate, and Fentanyl for Epidural Extension Anesthesia in Elective Cesarean Delivery: A Randomized, Triple-Blind, Noninferiority Study. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2020 Aug 25;132(3):666–75. Available from: https://doi.org/10.1213/ane.0000000000005141

Guasch E, Brogly N, Mercier FJ, Ioscovich A, Weiniger CF, Lucas N, et al. European minimum standards for obstetric analgesia and anaesthesia departments. European Journal of Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2020 Oct 16;37(12):1115–25. Available from: https://doi.org/10.1097/eja.0000000000001362

Epidural anaesthesia: how to convert a labour analgesia epidural into a surgical anaesthetic block (GL757). Available from: https://www.royalberkshire.nhs.uk/Downloads/GPs/GP%20protocols%20and%20guidelines/Maternity%20Guidelines%20and%20Policies/Anaesthetics%20relating%20to%20Obstetrics/Epidural_labour_anaes_convert_to_surgical_block_V7.0_GL757_NOV18.pdf

Halpern SH, Soliman A, Yee J, Angle P, Ioscovich A. Conversion of epidural labour analgesia to anaesthesia for Caesarean section: a prospective study of the incidence and determinants of failure. British Journal of Anaesthesia [Internet]. Elsevier BV; 2009 Feb;102(2):240–3. Available from: https://doi.org/10.1093/bja/aen352

PRO and CON: Using a Labor Epidural for Cesarean Delivery – CON: Pull the Epidural Catheter and Perform a Spinal. Available from: https://www.apsf.org/article/pro-and-con-using-a-labor-epidural-for-cesarean-delivery-con-pull-the-epidural-catheter-and-perform-a-spinal

Bauer ME, Kountanis JA, Tsen LC, Greenfield ML, Mhyre JM. Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials. International Journal of Obstetric Anesthesia [Internet]. Elsevier BV; 2012 Oct;21(4):294–309. Available from: https://doi.org/10.1016/j.ijoa.2012.05.007

Kinsella SM, Girgirah K, Scrutton MJL. Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series. Anaesthesia [Internet]. Wiley; 2010 Mar 19;65(7):664–9. Available from: https://doi.org/10.1111/j.1365-2044.2010.06368.x

Varandas JS, Dias R, Mendes AB, Lages N, Machado H. New indication for an old anesthetic technique: could we consider now rapid sequence spinal anesthesia in a COVID-19 time? Regional Anesthesia & Pain Medicine [Internet]. BMJ; 2020 May 6;46(2):191.1–191. Available from: https://doi.org/10.1136/rapm-2020-101572

Конверсія епідуральної аналгезії в анестезію  для кесаревого розтину

Published

2021-04-24

How to Cite

1.
Grizhimalsky Y, Harha A, Sulimenko Y. Conversion of epidural analgesia to anesthesia for cesarean section. PMJUA [Internet]. 2021 Apr. 24 [cited 2021 Jun. 21];6(1):4-7. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/245

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Problem article