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Failed spinal anesthesia for cesarean delivery: prevention, identification and management
Thierry Girard1, Georges L Savoldelli2
1Department of Anaesthesiology, University Hospital Basel, University of Basel, Basel.
Current Opinion in Anaesthesiology
|February 16, 2024
Summary
Effective spinal anesthesia for cesarean delivery requires block testing to prevent intraoperative pain. Management strategies for block failure include repeat neuraxial techniques or general anesthesia, with informed consent crucial for patient safety.
Area of Science:
- Anesthesiology
- Obstetrics
- Pain Management
Background:
- Intraoperative pain during cesarean delivery is a recognized concern.
- Spinal anesthesia failure can occur preoperatively or intraoperatively.
- Identifying and managing intraoperative pain requires specific strategies.
Purpose of the Study:
- To highlight the importance of preoperative block testing for spinal anesthesia in cesarean delivery.
- To discuss risk factors and prevention of neuraxial block failure.
- To outline management strategies for intraoperative pain and block failure.
Main Methods:
- Review of current knowledge on spinal anesthesia for cesarean delivery.
- Analysis of risk factors for block failure.
- Evaluation of management options for intraoperative pain and neuraxial failure.
Main Results:
- Block testing is essential for identifying preoperative spinal anesthesia failure.
- Intraoperative pain is common and challenging to detect by clinicians.
- Early and late intraoperative pain require distinct treatment approaches.
Conclusions:
- Preoperative block testing is crucial for spinal anesthesia success in cesarean delivery.
- Repeat neuraxial techniques, combined spinal-epidural, or epidural methods are viable options for block failure.
- Adequate treatment of intraoperative pain, including general anesthesia, and informed consent are vital.
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