Risk Factors for Failure to Extend Labor Epidural Analgesia to Epidural Anesthesia for Cesarean Section

S. Orbach-Zinger, L. Friedman, A. Avramovich, N. Ilgiaeva, R. Orvieto, J. Sulkes, L. A. Eidelman

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Aim: To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS). Methods: For 6 months, we prospectively studied women undergoing CS with a functioning epidural catheter in place from the delivery ward. All parturients received the same epidural protocol: bolus of bupivacaine 0.1% and fentanyl, followed by bupivacaine 0.1% and fentanyl (2 μg/ml) 10-15 ml/h and an additional 5 ml of bupivacaine 0.125% as top-up according to patient request. Sixteen milliliters of lidocaine 2%, 1 ml of bicarbonate and 100 μg of fentanyl were given for CS. Failed epidural analgesia was defined as the need to convert to general anesthesia. Results: Of the 101 parturients studied, 20 (19.8%) required conversion to general anesthesia. In univariate analysis, the likelihood of failed epidural anesthesia was inversely correlated with parturient age (P = 0.014) and directly correlated with pre-pregnancy weight (P = 0.019), weight at the end of pregnancy (P = 0.003), body mass index at the end of pregnancy (P = 0.0004), gestational week (P = 0.008), number of top-ups (P = 0.0004) and visual analog scale (VAS) score 2 h before CS (P = 0.03). In multivariate analysis, the number of top-ups in the delivery ward was the best predictor of epidural anesthesia failure (odds ratio, 4.39; P = 0.005). Conclusion: Younger, more obese parturients at a higher gestational week, requiring more top-ups during labor and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.

Original languageEnglish
Pages (from-to)793-797
Number of pages5
JournalActa Anaesthesiologica Scandinavica
Issue number7
StatePublished - 6 Jul 2006
Externally publishedYes


  • Cesarean section
  • Epidural analgesia
  • Epidural anesthesia
  • General anesthesia
  • Labor

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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