Bagle Aparna, Khatri Shweta, Jain Runjhun
Department of Anaesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Cureus. 2024 Dec 20;16(12):e76078. doi: 10.7759/cureus.76078. eCollection 2024 Dec.
Introduction Spinal anesthesia, a commonly used technique for lower abdominal, pelvic, and lower extremity surgeries, involves injecting a local anesthetic into the subarachnoid space to temporarily block sensory, motor, and sympathetic nerves. Despite its high success rate, the failure of spinal anesthesia, which can lead to adverse patient outcomes, remains a concern. The failure rate varies widely, from 1% to 17%, influenced by factors such as technical challenges, patient anatomy, and practitioner experience. This study aims to determine the incidence and causes of spinal anesthesia failure in a university hospital setting. Methodology This cross-sectional, prospective observational study was conducted at Dr. D.Y. Patil Medical College and Research Centre, Pimpri, Pune. Data were collected from patients aged ≥18 years who underwent spinal anesthesia over one year. The study recorded various parameters, including patient demographics, surgical details, and anesthetic techniques. Failed spinal anesthesia was categorized into total failure (no block achieved) and partial failure (need for additional analgesia). Statistical analysis was performed to identify the incidence and contributing factors to spinal anesthesia failure. Results Out of 3933 patients receiving spinal anesthesia, 72 experienced failure, resulting in an incidence rate of 1.83%. The majority of failures were total (87.5%), with partial failures accounting for 12.5%. Among the cases of failed spinal anesthesia, failures were most common in obstetric surgeries (37.5%), followed by orthopedic (25%), general (22.22%), and urologic (15.28%) surgeries. The highest failure rate according to surgery type in all patients receiving spinal anesthesia was seen in orthopedic surgery (3.46%) followed by urologic surgery (2.17%). Elective surgeries had a lower failure rate (1.39%) compared to emergency surgeries (3.87%). Quincke-type needles were predominantly used, and spinal anesthesia was most often administered at the L3-L4 intervertebral space in the sitting position. Notably, first-year residents had the highest failure rate (43.06%), while more experienced practitioners had lower failure rates. Conclusion The incidence of spinal anesthesia failure in our study was 1.83%, with total failures being more common than partial failures. Factors such as surgical type, emergency status, and practitioner experience can impact the failure rate. The higher failure rate among less experienced practitioners underscores the need for improved training and expertise. Regular monitoring and refinement of spinal anesthesia techniques are essential to enhance patient safety and optimize anesthetic care.
引言
脊髓麻醉是下腹部、盆腔和下肢手术常用的技术，通过将局部麻醉剂注入蛛网膜下腔，暂时阻断感觉神经、运动神经和交感神经。尽管脊髓麻醉成功率高，但麻醉失败仍令人担忧，因为这可能导致不良患者结局。其失败率差异很大，从1%到17%不等，受技术挑战、患者解剖结构和从业者经验等因素影响。本研究旨在确定大学医院环境中脊髓麻醉失败的发生率及原因。
方法
本横断面、前瞻性观察性研究在浦那皮姆普里的D.Y.帕蒂尔医学院和研究中心进行。收集年龄≥18岁且接受脊髓麻醉超过一年的患者的数据。该研究记录了各种参数，包括患者人口统计学、手术细节和麻醉技术。脊髓麻醉失败分为完全失败（未实现阻滞）和部分失败（需要额外镇痛）。进行统计分析以确定脊髓麻醉失败的发生率和相关因素。
结果
在3933例接受脊髓麻醉的患者中，72例出现失败，发生率为1.83%。大多数失败为完全失败（87.5%），部分失败占12.5%。在脊髓麻醉失败病例中，产科手术失败最为常见（37.5%），其次是骨科（25%）、普通外科（22.22%）和泌尿外科（15.28%）手术。在所有接受脊髓麻醉的患者中，根据手术类型，骨科手术失败率最高（3.46%），其次是泌尿外科手术（2.17%）。择期手术失败率（1.39%）低于急诊手术（3.87%）。主要使用奎克型针，脊髓麻醉最常在坐位的L3-L4椎间隙进行。值得注意的是，第一年住院医师失败率最高（43.06%），而经验更丰富的从业者失败率较低。
结论
我们研究中脊髓麻醉失败的发生率为1.83%，完全失败比部分失败更常见。手术类型、急诊状态和从业者经验等因素会影响失败率。经验不足的从业者失败率较高，凸显了改进培训和专业技能的必要性。定期监测和完善脊髓麻醉技术对于提高患者安全性和优化麻醉护理至关重要。
