Gago A, Guasch E, Gutiérrez C, Guiote P, Gilsanz F
Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid.
Rev Esp Anestesiol Reanim. 2009 Aug-Sep;56(7):412-6. doi: 10.1016/s0034-9356(09)70421-9.
Epidural analgesia provides effective control of labor pain and allows emergency cesarean section to be performed without recourse to general anesthesia. This technique is subject to failure, however. We sought to determine the incidence of failure of extension of epidural analgesia for labor to epidural anesthesia for emergency cesarean section. We also analyzed possible risk factors for failure. A 2-month observational study was carried out in a tertiary-care university hospital in patients who had an epidural catheter inserted for labor analgesia and who later underwent emergency cesarean section. Epidural catheter failure was defined if additional analgesia was required during surgery or if general anesthesia was required. Data were gathered on possible risk factors, such as obesity, difficult epidural puncture, leakage of blood on insertion, history of cesarean delivery, need for rescue analgesia, and level of satisfaction with analgesia during dilation. In total, 134 emergency cesareans were performed in women carrying an epidural catheter. The catheter failed to administer the anesthetic in 18 patients (13.4%). General anesthesia was required in 9 cases (6.7%). Difficult insertion (more than 2 attempts) was associated with a higher failure rate (P=.064). The relative risk of epidural catheter failure was 2.86-fold higher when rescue analgesia was needed during delivery than in cases when no supplement was required (P=.021). Receiving adequate analgesia during labor seems to be a protective factor (80%) against anesthetic catheter failure during cesarean section (P=.01). We conclude that high demand for rescue analgesia and signs of inadequate analgesia during labor should warn of epidural catheter failure if extension to anesthesia becomes necessary for a cesarean delivery.
硬膜外镇痛能有效控制分娩疼痛，并允许在不进行全身麻醉的情况下进行急诊剖宫产。然而，这项技术也可能失败。我们试图确定分娩时硬膜外镇痛扩展用于急诊剖宫产硬膜外麻醉的失败发生率。我们还分析了可能的失败风险因素。在一家三级医疗大学医院进行了为期2个月的观察性研究，研究对象为插入硬膜外导管进行分娩镇痛且后来接受急诊剖宫产的患者。如果手术期间需要额外镇痛或需要全身麻醉，则定义为硬膜外导管失败。收集了可能的风险因素数据，如肥胖、硬膜外穿刺困难、置管时血液渗漏、剖宫产史、需要补救镇痛以及扩张期镇痛满意度。共有134名携带硬膜外导管的女性进行了急诊剖宫产。18例患者（13.4%）的导管未能给药麻醉。9例（6.7%）需要全身麻醉。置管困难（超过2次尝试）与较高的失败率相关（P = 0.064）。分娩时需要补救镇痛的患者硬膜外导管失败的相对风险比不需要补充镇痛的患者高2.86倍（P = 0.021）。分娩期间接受充分镇痛似乎是剖宫产时麻醉导管失败的一个保护因素（80%）（P = 0.01）。我们得出结论，如果剖宫产分娩需要扩展为麻醉，那么对补救镇痛的高需求以及分娩期间镇痛不足的迹象应警示硬膜外导管失败。
