A comparison of anesthetic outcomes between activation and removal of epidural catheters for patients who underwent unscheduled intrapartum cesarean delivery

Abstract

Background

We hypothesized that patients who underwent unscheduled intrapartum cesarean delivery and had removal of an indwelling epidural catheter followed by an attempt of a new regional anesthetic would be more likely to have regional anesthesia without conversion to general anesthesia or administration of additional anesthetic medication compared to patients who had activation of an epidural catheter.

Methods

Patients who had an unscheduled intrapartum cesarean delivery from July 1, 2019, through June 30, 2021, who had an indwelling labor epidural catheter were included. Patients were propensity matched based on obstetric indication for cesarean delivery and number of physician-administered rescue analgesia boluses administered during labor. A multivariate proportional odds regression was performed.

Results

After adjusting for parity, depression, last neuraxial labor analgesic technique, physician-administered rescue analgesia boluses, and duration from neuraxial placement to entering the operating room for cesarean delivery, patients who had removal of their epidural catheters were more likely to have regional anesthesia without conversion to general anesthesia or administration of additional anesthetic medication (odds ratio 4.298; 95% confidence interval 2.448, 7.548; P < 0.01).

Conclusion

Removal of epidural catheters was associated with a greater chance of avoiding conversion to general anesthesia or administration of additional anesthetic medication.

Keywords:

• Analgesia
• cesarean section
• obstetrical anesthesia
• patient safety

Disclosure statement/Funding

The authors report no external funding or conflicts of interest.