Anaesthesia practices for caesarean delivery in three clinical scenarios: the French CLATAC survey (2022-2023)

Intraoperative pain during caesarean delivery (CD) remains a concern, particularly with epidural anaesthesia, with variable incidence depending on the circumstances. While spinal anaesthesia is the standard for scheduled CD, the best approach for unscheduled CD, especially with inadequate conversion of labour epidural analgesia to surgical epidural anaesthesia, remains unclear. We aimed to describe preferred anaesthetic practices among French anaesthesiologists in different clinical scenarios, with a particular focus on intrapartum CD with failed conversion of labour epidural analgesia.

A nation-wide, anonymous, online survey was distributed to anaesthesiologists. Participants were asked to indicate their preferred practices in clinical scenarios, including cases without labour epidural analgesia, with adequate labour epidural analgesia, and with inadequate conversion to surgical epidural anaesthesia, for three emergency levels.

Between November 2022 and January 2023, 651 anaesthesiologists responded. Most respondents indicated preferring spinal anaesthesia for scheduled (97 %) and unscheduled non-urgent CD without LEA (95 %). In emergency situations, general anaesthesia (GA) was preferred (84 %). With adequate labour epidural analgesia, 99 % favoured epidural conversion. With inadequate labour epidural analgesia, 43 % indicated preferring spinal anaesthesia in non-urgent situations, while 70 % would opt for GA in emergency cases. Only 63 % of respondents were aware of risk factors for epidural conversion failure.

Anaesthetic practices were heterogeneous, particularly with inadequate labour epidural analgesia. These findings highlight the need for broader dissemination of updated guidelines and for standardized, evidence-based, clinical decision algorithms to support safe and effective anaesthetic management in complex clinical scenarios.