The incidence and factors associated with failed spinal anesthesia among parturients underwent cesarean section, 2019: A prospective observational study

Background: Spinal anesthesia is the method of choice for cesarean section as it is associated with low occurrence of intra-operative and post-operative morbidities. Despite this signi ficant move towards spinal anesthesia, it has a risk of failure reported in the range of 1-17%. Failed spinal is a disgusting event for the mother and the anesthetist that may lead to decreased maternal satisfaction and may potentially impact fetal and maternal outcomes. Objective: The study was designed to determine the incidence and factors associated with failed spinal anesthesia during cesarean section. Methods: A prospective institution based observational study was conducted on 275 parturients from October 1st to December 31st, 2019. After collection, the data was data entered and analyzed by SPSS version 21. The main outcome measure was the incidence of failed spinal anesthesia and the chi-square test was used to compare failure rates and multivariable regression analysis was performed to investigate potential factors. Results: The study involved 275 parturients and the overall incidence of failed spinal was 19.5%. Co- morbidity (OR = 9.615; CI = 1.255-7.368), emergency procedure (AOR = 2.191; CI = 1.087-4.417), needle size (2.3; CI = 0.92-0.615), anesthetist's experience (AOR = 4.23; CI = 2.14-8.34), surgeon's experience (AOR = 2.530; CI = 1.319-4.853), bloody CSF flow (AOR = 2.440; CI = 0.103-0.582), and volume of local anesthetics (AOR = 2.781; CI = 1.432-5.398) were signi ficantly associated with failed spinal anesthesia. Conclusions and recommendations: The incidence of failed spinal anesthesia was found to be high compared to previous studies. Since the study tried to identify risk factors for failure, we should act accordingly to minimize the failure rate. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).