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Anesth Pain Med > Volume 10(3); 2015 > Article
Obstetric Anesthesia
Anesthesia and Pain Medicine 2015;10(3):203-207.
DOI:    Published online July 31, 2015.
Effectiveness of spinal anesthesia after epidural labor analgesia versus spinal anesthesia only for intrapartum cesarean section
Joo Yeon Jeon, Sang Hwan Do, In Ho Lee, Young Seok Jee, Seung In Park, Hea Jo Yoon
1Department of Anesthesiology and Pain Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
2Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Received: 27 January 2015   • Revised: 2 February 2015   • Accepted: 9 April 2015
Spinal anesthesia (SA) after epidural labor analgesia (ELA) can have advantages over augmentation of ELA due to its rapid onset and high-quality analgesia. However, unexpected side effects and diverse failure rates have been reported in women that received SA after ELA. We prospectively compared the effectiveness and side effects of SA after ELA versus SA only for intrapartum cesarean section.
The ELA/SA group received continuous epidural infusion at a rate of 10 ml/h for labor pain. In both groups, spinal anesthesia was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 microg of fentanyl using a pencil point needle. The rate of conversion to general anesthesia, the need for intraoperative analgesic supplements, and the incidence of high spinal block and hypotension were investigated.
The rate of conversion to general anesthesia was higher in the ELA/SA group compared with the SA group (15.2 vs. 2.7%). Eighty percent of the conversion cases in the ELA/SA group were converted due to lack of sensory block. The need for intraoperative analgesic supplements and the rates of high spinal block and hypotension were comparable in the two groups.
SA after ELA is associated with a high rate of conversion to general anesthesia during intrapartum cesarean section.
Key Words: Conversion to general anesthesia, Epidural analgesia, Failed spinal anesthesia, Intrapartum cesarean section

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