Servicio de Anestesiología y Reanimación, Hospital universitario La Paz, Madrid, Spain.
Servicio de Anestesiología y Reanimación, Hospital universitario La Paz, Madrid, Spain.
Braz J Anesthesiol. 2021 May-Jun;71(3):214-220. doi: 10.1016/j.bjane.2021.02.054. Epub 2021 Apr 9.
Obesity is becoming a frequent condition among obstetric patients. A high body mass index (BMI) has been closely related to a higher difficulty to perform the neuraxial technique and to the failure of epidural analgesia. Our study is aimed at analyzing obese obstetric patients who received neuraxial analgesia for labor at a tertiary hospital and assessing aspects related to the technique and its success.
Retrospective observational descriptive study during one year. Women with a BMI higher than 30 were identified, and variables related to the difficulty and complications of performing the technique, and to analgesia failure rate were assessed.
Out of 3653 patients, 27.4% had their BMI ≥ 30 kg.m-². Neuraxial techniques are difficult to be performed in obese obstetric patients, as showed by the number of puncture attempts (≥ 3 in 9.1% obese versus 5.3% in non-obese being p < 0.001), but the incidence of complications, as hematic puncture (6.6%) and accidental dural puncture (0.7%) seems to be similar in both obese and non-obese patients. The incidence of cesarean section in obese patients was 23.4% (p < 0.001). Thus, an early performance of epidural analgesia turns out to be essential to control labor pain and to avoid a general anesthesia in such high-risk patients.
肥胖症在产科患者中越来越常见。高体重指数（BMI）与进行神经轴突技术的难度增加以及硬膜外镇痛失败密切相关。我们的研究旨在分析在一家三级医院接受分娩神经轴突镇痛的肥胖产科患者，并评估与技术及其成功率相关的方面。
在一年期间进行回顾性观察描述性研究。确定 BMI 高于 30 的女性，并评估与技术难度和并发症以及镇痛失败率相关的变量。
在 3653 名患者中，27.4%的患者 BMI≥30kg.m-²。肥胖产科患者的神经轴突技术难以实施，表现为穿刺尝试次数（≥3 次，肥胖患者为 9.1%，非肥胖患者为 5.3%，p<0.001），但出血性穿刺（6.6%）和意外硬脊膜穿刺（0.7%）等并发症的发生率在肥胖和非肥胖患者中似乎相似。肥胖患者的剖宫产率为 23.4%（p<0.001）。因此，早期进行硬膜外镇痛对于控制分娩疼痛和避免此类高风险患者的全身麻醉至关重要。
