Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section
Objective To summarise the process of conversion of epidural labour analgesia to anaesthesia for caesarean delivery and explore the relationship between duration of labour analgesia and conversion.Methods Parturients who underwent conversion from epidural labour analgesia to anaesthesia for caesarea...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-12-01
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| Series: | Annals of Medicine |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/07853890.2022.2067353 |
| _version_ | 1811303643264057344 |
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| author | Zhang Jian Ran Longqing Wei Dayuan Jia Fei Liu Bo Zhang Gang Zhu Siying Gao Yan |
| author_facet | Zhang Jian Ran Longqing Wei Dayuan Jia Fei Liu Bo Zhang Gang Zhu Siying Gao Yan |
| author_sort | Zhang Jian |
| collection | DOAJ |
| description | Objective To summarise the process of conversion of epidural labour analgesia to anaesthesia for caesarean delivery and explore the relationship between duration of labour analgesia and conversion.Methods Parturients who underwent conversion from epidural labour analgesia to anaesthesia for caesarean delivery between May 2019 and April 2020 at the Chengdu Women’s and Children’s Central Hospital, Sichuan Maternal and Child Health Hospital, and Jinjiang District Maternal and Child Health Hospital were selected. If the position of the epidural catheter was correct and the effect was good, patients were converted to epidural surgical anaesthesia. If epidural labour analgesia was ineffective, spinal anaesthesia (SA) was administered immediately. For category-1 emergency caesarean sections, general anaesthesia (GA) was administered.Results A total of 1084 parturients underwent conversion. Of these, 19 (1.9%) received GA due to the initiation of category-1 emergency caesarean section. 704 (64.9%) were converted to epidural surgical anaesthesia, 2 (0.2%) had failed conversions and were administered GA before delivery, and 357 (32.9%) were converted to SA. Logistic regression analysis showed that prolonged duration of epidural labour analgesia ([Crude odds ratio (OR)=1.065; 95% confidence interval (CI), 1.037–1.094; p < .01]; [Adjusted OR = 1.060; 95% CI, 1.031–1.091; p < .01]) was an independent risk factor for conversion failure. A receiver operating characteristic curve constructed using duration of epidural labour analgesia showed that parturients with a duration of epidural labour analgesia ≥8 h, more frequently required a change of anaesthesia technique during conversion, and the relative risk of conversion failure was 1.54 (95% CI, 1.23–1.93; p < .01).Conclusion Prolonged duration of epidural labour analgesia increases the possibility of having an invalid epidural catheter, resulting in an increased risk of conversion failure from epidural labour analgesia to epidural surgical anaesthesia. Further, this risk is higher when the time exceeds 8 h. KEY MESSAGESProlonged duration of epidural labour analgesia > 8 h is associated with conversion failure.If it is impossible to judge whether the conversion is successful immediately, spinal anaesthesia should be administered to minimise complications. |
| first_indexed | 2024-04-13T07:51:25Z |
| format | Article |
| id | doaj.art-cae834d9da494414807307af6a8a8bdc |
| institution | Directory Open Access Journal |
| issn | 0785-3890 1365-2060 |
| language | English |
| last_indexed | 2024-04-13T07:51:25Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
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| series | Annals of Medicine |
| spelling | doaj.art-cae834d9da494414807307af6a8a8bdc2022-12-22T02:55:31ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602022-12-015411112111710.1080/07853890.2022.2067353Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean sectionZhang Jian0Ran Longqing1Wei Dayuan2Jia Fei3Liu Bo4Zhang Gang5Zhu Siying6Gao Yan7Sichuan Provincial Maternity and Child Health Care Hospital (Women’s and Children’s Hospital Affiliated of Chengdu Medical College), ChengduChengdu Women’s and Children’s Central Hospital (School of Medicine, University of Electronic Science and Technology of China), ChengduChengdu Medical College, ChengduJinjiang Maternity and Child Health Hospital, ChengduJinjiang Maternity and Child Health Hospital, ChengduSichuan Provincial Maternity and Child Health Care Hospital (Women’s and Children’s Hospital Affiliated of Chengdu Medical College), ChengduSichuan Provincial Maternity and Child Health Care Hospital (Women’s and Children’s Hospital Affiliated of Chengdu Medical College), ChengduSichuan Provincial Maternity and Child Health Care Hospital (Women’s and Children’s Hospital Affiliated of Chengdu Medical College), ChengduObjective To summarise the process of conversion of epidural labour analgesia to anaesthesia for caesarean delivery and explore the relationship between duration of labour analgesia and conversion.Methods Parturients who underwent conversion from epidural labour analgesia to anaesthesia for caesarean delivery between May 2019 and April 2020 at the Chengdu Women’s and Children’s Central Hospital, Sichuan Maternal and Child Health Hospital, and Jinjiang District Maternal and Child Health Hospital were selected. If the position of the epidural catheter was correct and the effect was good, patients were converted to epidural surgical anaesthesia. If epidural labour analgesia was ineffective, spinal anaesthesia (SA) was administered immediately. For category-1 emergency caesarean sections, general anaesthesia (GA) was administered.Results A total of 1084 parturients underwent conversion. Of these, 19 (1.9%) received GA due to the initiation of category-1 emergency caesarean section. 704 (64.9%) were converted to epidural surgical anaesthesia, 2 (0.2%) had failed conversions and were administered GA before delivery, and 357 (32.9%) were converted to SA. Logistic regression analysis showed that prolonged duration of epidural labour analgesia ([Crude odds ratio (OR)=1.065; 95% confidence interval (CI), 1.037–1.094; p < .01]; [Adjusted OR = 1.060; 95% CI, 1.031–1.091; p < .01]) was an independent risk factor for conversion failure. A receiver operating characteristic curve constructed using duration of epidural labour analgesia showed that parturients with a duration of epidural labour analgesia ≥8 h, more frequently required a change of anaesthesia technique during conversion, and the relative risk of conversion failure was 1.54 (95% CI, 1.23–1.93; p < .01).Conclusion Prolonged duration of epidural labour analgesia increases the possibility of having an invalid epidural catheter, resulting in an increased risk of conversion failure from epidural labour analgesia to epidural surgical anaesthesia. Further, this risk is higher when the time exceeds 8 h. KEY MESSAGESProlonged duration of epidural labour analgesia > 8 h is associated with conversion failure.If it is impossible to judge whether the conversion is successful immediately, spinal anaesthesia should be administered to minimise complications.https://www.tandfonline.com/doi/10.1080/07853890.2022.2067353Labour analgesiacaesarean sectionepidural anaesthesiaspinal anaesthesiaduration of epidural labour analgesia |
| spellingShingle | Zhang Jian Ran Longqing Wei Dayuan Jia Fei Liu Bo Zhang Gang Zhu Siying Gao Yan Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section Annals of Medicine Labour analgesia caesarean section epidural anaesthesia spinal anaesthesia duration of epidural labour analgesia |
| title | Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section |
| title_full | Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section |
| title_fullStr | Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section |
| title_full_unstemmed | Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section |
| title_short | Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section |
| title_sort | prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section |
| topic | Labour analgesia caesarean section epidural anaesthesia spinal anaesthesia duration of epidural labour analgesia |
| url | https://www.tandfonline.com/doi/10.1080/07853890.2022.2067353 |
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