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Review
. 2024 Jun 1;37(3):207-212.
doi: 10.1097/ACO.0000000000001362. Epub 2024 Feb 15.

Failed spinal anesthesia for cesarean delivery: prevention, identification and management

Thierry Girard  1 , Georges L Savoldelli  2
Affiliations
Review

Failed spinal anesthesia for cesarean delivery: prevention, identification and management

Thierry Girard et al. Curr Opin Anaesthesiol. .

Abstract

Purpose of review: There is an increasing awareness of the significance of intraoperative pain during cesarean delivery. Failure of spinal anesthesia for cesarean delivery can occur preoperatively or intraoperatively. Testing of the neuraxial block can identify preoperative failure. Recognition of the risk of high neuraxial block in repeat spinal in case of preoperative failure is important.

Recent finding: Knowledge of risk factors for block failure facilitates prevention by selecting the most appropriate neuraxial procedure, adequate intrathecal doses and choice of technique. Intraoperative pain is not uncommon, and neither obstetricians nor anesthesiologists can adequately identify intraoperative pain. Early intraoperative pain should be treated differently from pain towards the end of surgery.

Summary: Block testing is crucial to identify preoperative failure of spinal anesthesia. Repeat neuraxial is possible but care must be taken with dosing. In this situation, switching to a combined spinal epidural or an epidural technique can be useful. Intraoperative pain must be acknowledged and adequately treated, including offering general anesthesia. Preoperative informed consent should include block failure and its management.

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Conflict of interest statement

There are no conflicts of interest.

Figures

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References

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    2. The view of the patient is invaluable in the discussion on intraoperative pain. The author arguments against conversion rate to general anesthesia being a useful measure of intraoperative pain.

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