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https://soap.org/members/soap-expert-opinions/management-of-a-failed-labor-epidural/
If the patient is in need of a cesarean delivery, consider a spinal, CSE or general anesthesia, based on the emergent nature of the delivery. Epidural Provides One-Sided Analgesia:For a unilateral block, the patient should be placed on the side with inadequate analgesia, and the epidural catheter redosed with a local anesthetic. If the epidural catheter is > 5 cm within the epidural space or does not obtain …
https://www.apsf.org/article/pro-and-con-using-a-labor-epidural-for-cesarean-delivery-con-pull-the-epidural-catheter-and-perform-a-spinal/
Pain during cesarean delivery (CD) is distressing for a patient, and a leading cause of litigation in obstetric anesthesia. 1 It is critical that when providing anesthesia for CD that the parturient is as comfortable as possible. 2,3 In parturients who require CD with a labor epidural catheter in situ, surgical anesthesia is frequently initiated by administering a bolus of local anesthetic (LA) via the epidural catheter…
https://journals.lww.com/anesthesia-analgesia/pages/articleviewer.aspx?year=2016&issue=11000&article=00017&type=Fulltext
A prospective study reported a 25% epidural conversion failure when the indication for the cesarean delivery was an immediate threat to life, either fetal or maternal. 1 A meta-analysis of 7 studies concluded that urgency was a risk factor for epidural conversion failure (OR, 40.4; 95% CI, 8.8–185.6). 23 Unfortunately, this analysis is weakened by significant study heterogeneity. For example, many …
https://journals.lww.com/anesthesia-analgesia/pages/articleviewer.aspx?year=2009&issue=04000&article=00067&type=Fulltext
Labor epidural anesthetics converted to cesarean delivery epidural anesthetics had a failure rate of 0.42%, whereas primary epidural anesthetics for elective cesarean delivery had a failure rate …
https://www.apsf.org/article/pro-and-con-using-a-labor-epidural-for-cesarean-delivery-pro-dose-the-epidural-for-surgical-anesthesia/
Labor patients requiring intrapartum cesarean delivery (CD) may present with an indwelling epidural catheter to anesthesia professionals on Labor and Delivery (L&D). Dosing the labor epidural to achieve surgical anesthesia should be considered as the first-line approach.
https://www.clinicalpainadvisor.com/home/decision-support-in-medicine/anesthesiology/cesarean-delivery-spinal-epidural-or-combined-spinal-epidural-cse-anesthesia/
Whether a neuraxial technique is the appropriate anesthetic choice for cesarean delivery will depend on the urgency of the procedure based on fetal or maternal issues, the presence of any significant maternal comorbidities or instability, and on occasion, whether a functioning labor epidural is already in place.Author: Mccallum Hoyt
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