Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL, USA.
Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL, USA; Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA.
Int J Obstet Anesth. 2021 Nov;48:103176. doi: 10.1016/j.ijoa.2021.103176. Epub 2021 May 1.
The failure rate of neuraxial labor analgesia has not been investigated in super-obese women (body mass index ≥50 kg/m).
We performed a retrospective study of neuraxial labor analgesia in super-obese women (January 2012 to August 2019). The primary outcome was the failure rate of the first neuraxial catheter. Secondary outcomes were failure rates by neuraxial technique, at cesarean delivery, and rate of catheter replacement.
Neuraxial labor analgesia was used by 233 super-obese women: 153 epidural catheters placed using a combined spinal-epidural (CSE) or dural puncture epidural techniques with visualization of cerebrospinal fluid; 63 placed without dural puncture (including procedures without attempted dural puncture or attempted CSE or dural puncture epidural); and 17 intrathecal catheters (seven intentional). Thirty-two of 233 neuraxial catheters failed (13.7%, 95% Confidence Interval [CI] 9.9 to 18.7%). Epidural catheters placed using CSE or dural puncture epidural had a lower failure rate than those placed without dural puncture (9.2%, 95% CI 5.5% to 14.7%) vs 28.6% (95% CI 18.9% to 40.7%; P<0.001). Catheter migration was documented for 29.4% (95% CI 16.8 to 46.2%) of catheters that failed.
Epidural catheters placed using CSE or dural puncture epidural techniques were more reliable than those placed without dural puncture in super-obese parturients. It is unclear whether the result was driven by grouping procedures without attempted dural puncture with those in which dural puncture was attempted but cerebrospinal fluid was not obtained. Catheter migration was a major source of failure.
尚未对超级肥胖女性（体重指数≥50kg/m）的椎管内分娩镇痛失败率进行研究。
我们对超级肥胖女性（2012 年 1 月至 2019 年 8 月）的椎管内分娩镇痛进行了回顾性研究。主要结局为首次椎管内导管失败率。次要结局为椎管内技术失败率、剖宫产时失败率和导管更换率。
233 例超级肥胖女性接受了椎管内分娩镇痛：153 例采用联合腰麻-硬膜外（CSE）或硬脊膜穿刺硬膜外技术，同时观察到脑脊液；63 例无硬脊膜穿刺（包括无硬脊膜穿刺尝试或尝试 CSE 或硬脊膜穿刺硬膜外的操作）；17 例蛛网膜下腔置管（7 例为故意）。233 例椎管内导管中有 32 例失败（13.7%，95%置信区间[CI]9.9%至 18.7%）。采用 CSE 或硬脊膜穿刺硬膜外技术放置的硬膜外导管失败率低于无硬脊膜穿刺的导管（9.2%，95%CI 5.5%至 14.7%），而 28.6%（95%CI 18.9%至 40.7%；P<0.001）。记录到 29.4%（95%CI 16.8%至 46.2%）的失败导管存在导管迁移。
在超级肥胖产妇中，采用 CSE 或硬脊膜穿刺硬膜外技术放置的硬膜外导管比无硬脊膜穿刺的导管更可靠。尚不清楚这一结果是否是由于将未尝试硬脊膜穿刺的操作与尝试硬脊膜穿刺但未获得脑脊液的操作分组所致。导管迁移是失败的主要原因。
