FACTORS OF FAILED SPINAL ANESTHESIA IN DIFFERENT SURGICAL PROCEDURES AT TERTIARY CARE HOSPITALS DISTRICT PESHAWAR, PAKISTAN
DOI:
https://doi.org/10.71000/wzy14q34Keywords:
anesthesia failure, spinal anesthesia, , local anesthetic, , procedural technique, Back Pain, Obesity, SurgeryAbstract
Background: Spinal anesthesia is a widely preferred technique for surgeries involving the lower extremities and abdomen due to its rapid onset, predictable blockade, and reduced systemic complications. Despite its efficacy, failures still occur, leading to intraoperative discomfort, delayed procedures, or conversion to general anesthesia. Understanding the underlying demographic and procedural factors influencing spinal anesthesia outcomes is essential to enhance safety and effectiveness in clinical practice.
Objective: To identify patient-specific and procedural factors associated with the success and failure of spinal anesthesia in surgical patients.
Methods: A cross-sectional analytical study was conducted on 175 patients undergoing various elective and emergency surgeries under spinal anesthesia. Data on patient demographics, BMI, clinical history, surgery type and urgency, needle type, number of puncture attempts, local anesthetic type and dose, and intraoperative pain were collected. Logistic regression was used to identify significant predictors of spinal anesthesia failure, with statistical significance set at p<0.05.
Results: Spinal anesthesia failed in 15 out of 175 patients (8.57%). Significant predictors included underweight status (OR 4.76, p=0.049), obesity (OR 3.21, p=0.074), back pain history (OR 6.31, p=0.003), and previous spine surgery (OR 9.14, p=0.001). Procedural risk factors were Quincke needle use (OR 3.82, p=0.027), multiple puncture attempts—especially more than three (OR 10.53, p=0.002), use of Lidocaine (OR 10.5, p=0.001) or Ropivacaine (OR 8.4, p=0.018) instead of Bupivacaine, and low anesthetic dose (OR 0.69 per mg, p=0.041). Pain during incision (OR 6.72, p=0.002) and emergency surgery (OR 5.11, p=0.007) were also significantly associated with failure.
Conclusion: Spinal anesthesia outcomes are influenced by a combination of patient-related conditions and technical decisions. Recognizing these factors can help tailor anesthesia strategies, reduce failure rates, and enhance procedural safety.
References
Girard T, Savoldelli GL. Failed spinal anesthesia for cesarean delivery: prevention, identification and management. Curr Opin Anaesthesiol. 2024;37(3):207-12.
Bagle A, Khatri S, Jain R. Failed Spinal Anesthesia: Incidence and Associated Factors. Cureus. 2024;16(12):e76078.
Hötschl F, Lirk P, Marti F. [Failure of local anesthesia : Technical inadequacy or true resistance?]. Anaesthesiologie. 2023;72(2):106-8.
Wiskott K, Jebrin R, Ioscovich D, Grisaru-Granovsky S, Tevet A, Shatalin D, et al. General Versus Regional Anesthesia for Emergency Cesarean Delivery in a High-volume High-resource Referral Center: A Retrospective Cohort Study. Rom J Anaesth Intensive Care. 2020;27(2):6-10.
Tholin M, Wilson J, Lee S, Tang R, Sawka A, Vaghadia H. Impact of leg movement on skin-adductor canal distance: a potential cause for catheter tip displacement? Can J Anaesth. 2020;67(8):936-41.
Qu Y, Fu Q, Qin X, Zhuo Y, Chen Z, Qu L. The initial experience of 4.5/6.5 Fr ureteroscopic laser lithotripsy under topical intraurethral anesthesia supplemented by preoperative and intraoperative medications. Int Urol Nephrol. 2023;55(7):1677-84.
Lee A, Shatil B, Landau R, Menon P, Smiley R. Intrathecal 2-Chloroprocaine 3% Versus Hyperbaric Bupivacaine 0.75% for Cervical Cerclage: A Double-Blind Randomized Controlled Trial. Anesth Analg. 2022;134(3):624-32.
Chandrashekar AS, Hymel AM, Pennings JS, Wilson JM, Gupta RK, Polkowski GG, et al. Is a Failed Spinal Attempt Associated With a Worse Clinical Course Following Primary Total Hip and Knee Arthroplasty? J Arthroplasty. 2024;39(11):2669-74.e1.
Schutte SS, Euliano T. Local anesthetic resistance in a Crohn's patient undergoing cesarean delivery. Reg Anesth Pain Med. 2020;45(8):669-70.
Ravi R, Dirven CMV, Senthilnathan M, Sivakumar RK. Predictors of Failed Spinal Anesthesia After Intrathecal Injection of Local Anesthetic for Cesarean Delivery: Are We Omitting the Omission Variable Bias? Anesth Analg. 2024;139(4):e36-e8.
Ansari J, Sheikh M, Riley E, Guo N, Traynor A, Carvalho B. A retrospective cohort study of the anesthetic management of postpartum tubal ligation. Int J Obstet Anesth. 2024;58:103974.
Chao WH, Cheng WS, Hu LM, Liao CC. Risk factors for epidural anesthesia blockade failure in cesarean section: a retrospective study. BMC Anesthesiol. 2023;23(1):338.
Taka H, Kusama N, Sakamoto M, Sasano N, Tanaka M. A successful combined spinal-epidural anesthesia for cesarean section in a patient with neurofibromatosis type 1-associated dural ectasia. JA Clin Rep. 2024;10(1):61.
Punchuklang W, Nivatpumin P, Jintadawong T. Total failure of spinal anesthesia for cesarean delivery, associated factors, and outcomes: A retrospective case-control study. Medicine (Baltimore). 2022;101(27):e29813.
Melesse DY, Chekol WB, Tawuye HY, Denu ZA, Agegnehu AF. Assessment of the analgesic effectiveness of rectus sheath block in patients who had emergency midline laparotomy: Prospective observational cohort study. International Journal of Surgery Open. 2020 Jan 1; 24:27–31.
Ashagrie HE, Ahmed SA, Melesse DY. The incidence and factors associated with failed spinal anesthesia among parturients underwent cesarean section, 2019: A prospective observational study. International Journal of Surgery Open. 2020 Jan 1; 24:47–51.
Endalew NS, Tawuye HY, Melesse DY. Knowledge and attitude towards pain relief in labor among final year midwifery students: A cross-sectional study. International Journal of Surgery Open. 2020 Jan 1; 24:38–42.
Ehsani R, Motlagh SD, Zaman B, Kashani SS, Ghodraty MR. Effect of general versus spinal anesthesia on postoperative delirium and early cognitive dysfunction in elderly patients. Anesth Pain Med. 2020 Aug 1;10(4):1–8.
Colish J, Milne AD, Brousseau P, Uppal V. Factors Associated with Failure of Spinal Anesthetic: An 8-Year Retrospective Analysis of Patients Undergoing Elective Hip and Knee Joint Arthroplasty. Anesth Analg. 2020 Jan 1;130(1): E19–22.
Hulchafo A, Abiy S, Shifa S, Yemam D. Effectiveness of prophylactic intravenous ondasetron to reduce fentanyl induced pruritus among elective cesarean section patients in Worabe Comprehensive Specialized Hospital, Southern Ethiopia, 2020, randomized clinical trial. International Journal of Surgery Open. 2020 Jan 1; 24:52–6.
Yüksek A, Miniksar ÖH, Honca M, Öz H. Incidence and Causes of Failed Spinal Anesthesia. Dubai Medical Journal. 2020 Aug 1;3(2):50–4.
Stav M, Matatov Y, Hoffmann D, Heesen P, Gliesche V, Binyamin Y, et al. Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study. Acta Anaesthesiol Scand. 2023 Jan 1;67(1):29–35.
Yu C, Gu J, Liao Z, Feng S. Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies. Int J Obstet Anesth. 2021;47:103175.
Zetlaoui PJ, Buchheit T, Benhamou D. Epidural blood patch: A narrative review. Anaesth Crit Care Pain Med. 2022;41(5):101138.
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