Bloc neuroaxiaux chez la parturiente obèse

Obesity in parturients is defined by a body mass index (BMI) ≥ 30 kg/m2 before pregnancy. Obese parturients are at risk of complications such as arterial hypertension, fetal macrosomia, shoulder dystocia, emergency cesarean section… Morbidity and mortality are correlated to BMI. Management of obese parturients is supported by a multidisciplinary approach with experimented teams, specific devices and scheduled delivery. Epidural catheter should be placed early in the course of labor and secured due to the high risk of C-section for dystocia, order to avoid general anesthesia with a risk of difficult intubation. Lumbar epidural catheter placement is challenging in obese parturients (high failure rate, multiple attempts, catheter misplacement). Spinal anesthesia is the gold standard for scheduled C-section, the minimal effective dose of bupivacaine (with opioids) recommended is 10 mg. Combined spinal-epidural or continuous spinal anesthesia/analgesia may be considered as alternatives.