Fallo en la conversión de la analgesia epidural en anestesia epidural quirúrgica cuando se indica cesárea urgente

Epidural analgesia provides effective control of labor pain and allows emergency cesarean section to be performed without recourse to general anesthesia. This technique is subject to failure, however. We sought to determine the incidence of failure of extension of epidural analgesia for labor to epidural anesthesia for emergency cesarean section. We also analyzed possible risk factors for failure. A 2-month observational study was carried out in a tertiary-care university hospital in patients who had an epidural catheter inserted for labor analgesia and who later underwent emergency cesarean section. Epidural catheter failure was defined if additional analgesia was required during surgery or if general anesthesia was required. Data were gathered on possible risk factors, such as obesity, difficult epidural puncture, leakage of blood on insertion, history of cesarean delivery, need for rescue analgesia, and level of satisfaction with analgesia during dilation. In total, 134 emergency cesareans were performed in women carrying an epidural catheter. The catheter failed to administer the anesthetic in 18 patients (13.4%). General anesthesia was required in 9 cases (6.7%). Difficult insertion (more than 2 attempts) was associated with a higher failure rate (P = .064). The relative risk of epidural catheter failure was 2.86-fold higher when rescue analgesia was needed during delivery than in cases when no supplement was required (P = .021). Receiving adequate analgesia during labor seems to be a protective factor (80%) against anesthetic catheter failure during cesarean section (P = .01). We conclude that high demand for rescue analgesia and signs of inadequate analgesia during labor should warn of epidural catheter failure if extension to anesthesia becomes necessary for a cesarean delivery.