Efficacy of enhanced epidural anesthesia in patients undergoing cesarean section: a single-center retrospective observational study
10.3760/cma.j.cn131073.20230303.00915
- VernacularTitle:增效硬膜外麻醉用于剖宫产术患者的效果：单中心回顾性观察性研究
- Author:
Lujia YANG
1
;
Yongxin GUO
;
Yanhong LIU
;
Jing LIU
;
Li SUN
;
Hong WANG
;
Jiangbei CAO
;
Weidong MI
;
Hong ZHANG
Author Information
1. 解放军总医院第一医学中心麻醉科，北京 100853
- Keywords:
Anesthesia, obstetrical;
Anesthesia, epidural;
Retrospective studies
- From:
Chinese Journal of Anesthesiology
2023;43(9):1097-1102
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To retrospectively review the efficacy of enhanced epidural anesthesia in the patients undergoing cesarean section.Methods:The data from patients who underwent cesarean section in our hospital from August 2008 to December 2021 were retrospectively collected. The method of epidural anesthesia, drug dosage, onset time, blocking level, anesthesia effect, remedial medication, and complications related to the method were recorded. The main points of enhanced epidural anesthesia included: ① test negative pressure by rotating the epidural puncture needle in situ to determine the position of the needle tip; ② catheterization after administering local anesthetic through epidural puncture needle to assess the clinical application of this technique. A questionnaire survey was conducted in 134 anesthesiologists with qualifications for epidural procedures. The questionnaire addressed whether to perform routine needle rotation during epidural procedures, direction of needle rotation, and the percentage of the dosage of local anesthetic administered through puncture needle. Results:A total of 10 054 patients received epidural anesthesia (10 016 cases) and switched to general anesthesia because of poor epidural effect or intraoperative emergencies (38 cases) were enrolled. The consumption of local anesthetics for epidural anesthesia was 18 (15, 20) ml.There were 7 287 cases with block plane records, of which the ratio of the block level reached T 6-8 was 86.84%. The time from the beginning of anesthesia to skin incision was 25 (20, 30) min. Sixteen patients (0.159%) switched to general anesthesia because of poor epidural effect.Among 10 016 patients underwent epidural anesthesia, 925 patients (9.235%) received intravenous adjunctive drugs.No patients experienced total spinal anesthesia, 25 patients (0.248%) had epidural perforation due to puncture or needle rotation, and 4 cases (0.039%) local anesthetic intoxication, 3 cases (0.030%) postoperative nerve injury, and 142 patients (1.412%) requiring intervention with vasoactive drugs due to hemodynamic instability within 30 min after epidural administration. Questionnaire survey: The proportion of anesthesiologists rotating epidural puncture needles was 85.1%, and the proportion of anesthesiologists using epidural puncture needles to inject local anesthesia drugs with a dose greater than 50% of the total dose before catheterization was 84.2%. Conclusions:Enhanced epidural anesthesia can provide effective anesthesia for the patients undergoing cesarean section without increasing the risk of complications related to epidural procedures.
