The Choice of Anesthesia after First Failed Spinal Block and Its Impact on Maternal and Neonatal Outcomes in Cesarean Delivery: A Cross-Sectional Study

Abstract

Objective: The preferred choice of anesthesia for cesarean delivery is spinal block, which has a failure rate of 0.5% to 17.0%. The present study investigated the incident rate of second choice of anesthesia following a failed block, as well as the factors influencing the anesthesiologist’s selection. Materials and Methods: A single-center, retrospective cross-sectional study was conducted using electronic medical records of parturients who had experienced a failed spinal block for cesarean deliveries between 2014 and 2019. Each rate of repeated spinal block and the conversion to general anesthesia were calculated. Factors associated with the decision-making were examined, and maternal and neonatal outcomes were reviewed. Results: Three hundred four women were recruited. The rates of repeated block and conversion to general anesthesia were 81.2% and 18.8%, respectively. Dural puncture with more than one attempt (p=0.022) and anesthesia level at the thoracic dermatome (p<0.001) were associated with a lower decision to repeat the block. Maternal in the repeated block group had a higher incidence of hypotension at 59.5% (p<0.001) and shivering at 16.2% (p=0.008). Neonates in the repeat block group had a lower incidence of any complications than those in the conversion to general anesthesia group at 4% versus 29.8% (p<0.001). Conclusion: Following an unsuccessful spinal block for cesarean section, the repeated block was still preferred. The level of anesthesia and the spinal attempts were the significant factors in this choice. Keywords: Cesarean delivery; Conversion to general anesthesia; Failed spinal block; Maternal and neonatal outcomes; Repeat block