The quality of epidural anaesthesia for emergency C-section after labour analgesia

Abstract

Aim Spinal anaesthesia (SA) and epidural surgical anaesthesia (ESA) are both regularly used for caesarean section (CS) in women that received epidural labour analgesia (ELA). This study aimed to investigate the efficacy of ESA compared to SA in providing an adequate surgical block for CS after ELA.

Methods A retrospective cohort study was conducted on patients that underwent emergency CS after ELA between May 2021 and May 2023 in the Diakonessenhuis in Utrecht, the Netherlands. The primary outcome was adequate anaesthesia, defined as no conversion of anaesthesia and no administration of analgesics or sedatives during surgery. The secondary outcome was the pain- score within 6 hours post-surgery. Basic statistical tests were used to compare baseline data and outcomes. Multivariable logistic regression was used to adjust for confounders.

Results 202 patients were included, 116 received SA and 86 received ESA. Patients experienced adequate anaesthesia more often after SA (94.0% vs 74.4% respectively, adjusted OR: 6.45; 95% confidence interval [CI] 2.51 to 16.58). Of the components that assemble adequate anaesthesia, administration of analgesics during surgery was seen more often with ESA (23.3% vs 6.0%, adjusted OR, 5.70; 95% CI 2.20 – 14.75). Within 6 hours post-surgery a higher median pain-score was found after ESA (1.0; interquartile range [IQR] 0.0 to 2.0 for SA, versus 2.0; IQR 1.0 – 3.0 for ESA).

Conclusion In patients with ELA that underwent emergency CS, the use of SA led more often to an adequate surgical block and less often to administration of additional analgesics during surgery. Also, postoperative pain-scores were lower after SA compared to ESA.