Risk Factors for the Failure of Epidural Labor Analgesia Conversion to Cesarean Section Anesthesia and the Incidence of General Anesthesia: Systematic Review
Keywords:
cesarean section, conversion failure, epidural analgesia, labor pain management, neuraxial anesthesia, spinal analgesiaAbstract
Background: Epidural analgesia has become pivotal in modern obstetric care for managing labor pain, yet a notable percentage of recipients (4-14%) may require a cesarean section, prompting the need for effective epidural-to-surgical anesthesia conversion. This review aims to minimize the use of general anesthesia, which carries inherent risks and is discouraged in favor of safer alternatives like spinal or epidural anesthesia according to international guidelines. Methods: This systematic review focused on full-text English literature published between 2014 and 2024 using the PRISMA 2020 guidelines.The literature was compiled using PubMed, ScienceDirect, and SagePub, among other online venues. Result: Five publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Conclusion: Challenges with inadequate neuraxial anesthesia in elective cesarean sections underscore the need for optimized surgical conditions and pain relief strategies, while the conversion of labor epidural analgesia to anesthesia for emergency cesarean sections emphasizes the critical factors of anesthetic efficacy and procedural success rates in obstetric care.
References
Rahmati J, Shahriari M, Shahriari A, et al. Effectiveness of spinal analgesia for labor pain compared with epidural analgesia. Anesth Pain Med. 2021;11(2):e113350. doi:10.5812/aapm.113350.
Patel R, Kua J, Sharawi N, et al. Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review. Anaesthesia. 2022;77(5):598–604. doi:10.1111/anae.15657.
Anim-Somuah M, Smyth RM, Cyna AM, et al. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;5(5):Cd000331. doi:10.1002/14651858.CD000331.pub4.
Raafat Elghamry M, Naguib TM, Mansour RF. Anesthetic conversion of preexisting labor epidural analgesia for emergency cesarean section and efficacy of levobupivacaine with or without magnesium sulphate: a prospective randomized study. Anesth Pain Med. 2022;12(1):e121647. doi:10.5812/aapm.121647.
Choi SU. General anesthesia for cesarean section: are we doing it well? Anesth Pain Med (Seoul). 2022;17(3):256–261. doi:10.17085/apm.22196.
Yurashevich M, Carvalho B, Butwick AJ, et al. Determinants of women’s dissatisfaction with anaesthesia care in labour and delivery. Anaesthesia. 2019;74(9):1112–1120. doi:10.1111/anae.14756.
Hung KH, Tsao SL, Yang SF, et al. Association of general anesthesia and neuraxial anesthesia in caesarean section with maternal postpartum depression: a retrospective nationwide Population-Based cohort study. J Pers Med. 2022;12(6):970. doi:10.3390/jpm12060970.
Bauer ME, Kountanis JA, Tsen LC, et al. Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials. Int J Obstet Anesth. 2012;21(4):294–309. doi:10.1016/j.ijoa.2012.05.007.
Desai N, Gardner A, Carvalho B. Labor epidural analgesia to cesarean section anesthetic conversion failure: a national survey. Anesthesiol Res Pract. 2019;2019:6381792–6381797. doi:10.1155/2019/6381792.
Kim H, Shin SH, Ko MJ, et al. Correlation between anthropometric measurements and sensory block level of spinal anesthesia for cesarean section. Anesth Pain Med. 2021;11(5):e118627. doi:10.5812/aapm.118627.
Bonnet MP, Mercier FJ, Vicaut E, et al. Incidence and risk factors for maternal hypoxaemia during induction of general anaesthesia for non-elective caesarean section: a prospective multicentre study. Br J Anaesth. 2020;125(1):e81–e7. doi:10.1016/j.bja.2020.03.010.
Dunn CN, Zhang Q, Sia JT, et al. Evaluation of timings and outcomes in category-one caesarean sections: a retrospective cohort study. Indian J Anaesth. 2016;60(8):546–551. doi:10.4103/0019-5049.187782.
Chan Shen, Lin Chen, Chengjin Yue & Jing Cheng (2020): Extending epidural analgesia for intrapartum cesarean section following epidural labor analgesia: a retrospective cohort study, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2020.1743661
Grap SM, Patel GR, Huang J, Vaida SJ. Risk factors for labor epidural conversion failure requiring general anesthesia for cesarean delivery. J Anaesthesiol Clin Pharmacol 2022;38:118-23.
Zhang Jian, Ran Longqing, Wei Dayuan, Jia Fei, Liu Bo, Zhang Gang, Zhu Siying & Gao Yan (2022) Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section, Annals of Medicine, 54:1, 1112-1117, DOI: 10.1080/07853890.2022.2067353
Yoon HJ, Do SH, Yun YJ. Comparing epidural surgical anesthesia and spinal anesthesia following epidural labor analgesia for intrapartum cesarean section: a prospective randomized controlled trial. Korean J Anesthesiol. 2017;70(4):412-419. doi:10.4097/kjae.2017.70.4.412
Pan Li, Xiaoting Ma, Shuang Han, Izumi Kawagoe, Kurt Ruetzler, Amos Lal, Longlu Cao, Ran Duan & Jianli Li (2023) Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis, The Journal of Maternal-Fetal & Neonatal Medicine, 36:2, 2278020, DOI: 10.1080/14767058.2023.2278020
Lesniak A, Lipkowski AW. Opioid peptides in peripheral pain control. Acta Neurobiol Exp. 2011;71(1):129–138.
Pham B, Delage M, Girault A, et al. Risk factors for conversion to general anesthesia for urgent cesarean among women with labor epidural analgesia: a retrospective case-control study. J Gynecol Obstet Hum Reprod. 2022;51(9):102468. doi:10.1016/j.jogoh.2022. 102468.
Traynor AJ, Aragon M, Ghosh D, et al. Obstetric anesthesia workforce survey: a 30-year update. Anesth Analg. 2016;122(6):1939–1946. doi:10.1213/ ANE.0000000000001204.
Yeh HW, Yeh LT, Chou YH, et al. Risk of cardiovascular disease due to general anesthesia and neuraxial anesthesia in lower-limb fracture patients: a retrospective population-based cohort study. Int J Environ Res Public Health. 2019;17(1):33. doi:10.3390/ijerph17010033.
Mankowitz SK, Gonzalez Fiol A, Smiley R. Failure to extend epidural labor analgesia for cesarean delivery anesthesia: a focused review. Anesth Analg. 2016; 123(5):1174–1180. doi:10.1213/ANE.0000000000001437.
Cobb BT, Lane-Fall MB, Month RC, et al. Anesthesiologist specialization and use of general anesthesia for cesarean delivery. Anesthesiology. 2019; 130(2):237–246. doi:10.1097/ALN.0000000000002534.
Aksoy Derya Y, Timur Tas¸han S, Duman M, et al. Turkish adaptation of the pregnancy-related anxiety questionnaire-revised 2: validity and reliability study in multiparous and primiparous pregnancy. Midwifery. 2018;62:61–68. doi:10.1016/j.midw.2018.03.006.
Green G, Tesler R, Marques A. Primiparous and multiparous women’s mode of birth and negative emotions. Int J Environ Res Public Health. 2022;19(9): 5189. doi:10.3390/ijerph19095189.
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