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. 2021 May-Jun;71(3):214-220.
doi: 10.1016/j.bjane.2021.02.054. Epub 2021 Apr 9.

Epidural analgesia in the obese obstetric patient: a retrospective and comparative study with non-obese patients at a tertiary hospital

Claudia Cuesta González-Tascón  1 , Elena Gredilla Díaz  2 , Itsaso Losantos García  3
Affiliations

Epidural analgesia in the obese obstetric patient: a retrospective and comparative study with non-obese patients at a tertiary hospital

Claudia Cuesta González-Tascón et al. Braz J Anesthesiol. 2021 May-Jun.

Abstract

Background and objectives: Obesity is becoming a frequent condition among obstetric patients. A high body mass index (BMI) has been closely related to a higher difficulty to perform the neuraxial technique and to the failure of epidural analgesia. Our study is aimed at analyzing obese obstetric patients who received neuraxial analgesia for labor at a tertiary hospital and assessing aspects related to the technique and its success.

Methods: Retrospective observational descriptive study during one year. Women with a BMI higher than 30 were identified, and variables related to the difficulty and complications of performing the technique, and to analgesia failure rate were assessed.

Results and conclusions: Out of 3653 patients, 27.4% had their BMI ≥ 30 kg.m-². Neuraxial techniques are difficult to be performed in obese obstetric patients, as showed by the number of puncture attempts (≥ 3 in 9.1% obese versus 5.3% in non-obese being p < 0.001), but the incidence of complications, as hematic puncture (6.6%) and accidental dural puncture (0.7%) seems to be similar in both obese and non-obese patients. The incidence of cesarean section in obese patients was 23.4% (p < 0.001). Thus, an early performance of epidural analgesia turns out to be essential to control labor pain and to avoid a general anesthesia in such high-risk patients.

Keywords: Cesarean section; Labor analgesia; Neuraxial anesthesia; Obesity.

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Figure 1
Distribution of obesity grade among obese pregnant women.
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