Predictive factors of epidural rescue in combined spinal-epidural anesthesia for cesarean delivery

Combined spinal-epidural (CSE) is often recommended for cesarean deliveries expected to have prolonged duration. This study aimed to identify factors associated with the need for epidural rescue anesthesia during CSE for cesarean section, to better refine clinical indications for this technique.

This retrospective cohort study was conducted from 2020 to 2022 at the maternity of Toulouse University Hospital, France. Data were collected from 230 patients who underwent CSE for cesarean delivery. The mean age was 34.3 ± 5.6 years, 69.1% had previous cesarean sections, and 70% had a BMI > 24.9. Univariate analysis identified potential predictors, which were then included in multivariate logistic regression to determine independent factors associated with epidural rescue.

The overall rate of rescue epidural anesthesia was 16.5% (38/230). Multivariate analysis identified three independent predictors: gestational diabetes (adjusted odds ratio [aOR] 2.39, 95% CI: 1.07-5.29, p = 0.032), postpartum hemorrhage ≥ 500 mL (aOR 2.29, 95% CI: 1.35-3.90, p = 0.002), and surgical duration ≥ 62 minutes (aOR 4.36, 95% CI: 1.99-9.58, p < 0.001).

Gestational diabetes, postpartum hemorrhage, and surgical duration exceeding 62 minutes significantly increase the likelihood of epidural rescue during CSE for cesarean delivery. These findings could guide more selective CSE use, potentially avoiding unnecessary epidural catheter placement in low-risk situations.