Preanesthetic withdrawal improves the effect of prolonged epidural labor analgesia conversion to epidural surgery anesthesia: a prospective cohort study

Abstract

Abstract Background There are many factors affecting the failure of epidural labor analgesia (ELA) conversion to epidural surgery anesthesia (ESA). We hypothesized that preanesthetic withdrawal could improve the effect of prolonged ELA conversion to ESA. Methods This study prospectively observed parturients who converted the prolonged ELA to ESA. The parturients were divided into two groups according to whether the ELA was stopped before anesthesia. Group S: ELA was stopped more than 30 min before analgesia, Group NS: ELA was not stopped before analgesia. Epidural anesthesia was administered directly through the ELA catheter in both groups. The primary outcome was the failure rate of epidural anesthesia. The secondary outcomes were the intraoperative muscle relaxation effect, visceral pain, incision pain, intraoperative anesthesia effect and maternal satisfaction. Intraoperative anesthesia-related data, epidural labor analgesia-related data, and maternal and fetal data were also recorded. Results A total of 167 parturients were included in this prospective cohort study: 77 parturients were in Group S, and 88 parturients in Group NS. Compared with Group NS, Group S had a lower failure rate of epidural anesthesia (13% vs. 29.5%), higher excellent rate of muscle relaxation (90.3% vs. 78.2%), lower incidence of visceral pain (9.7% vs. 32.1%) and incision pain (9.7% vs. 15.9%), lower visual analog scale (VAS) of visceral pain (0 (0,0) vs. 0 (0,3)) and incision pain (0 (0,0) vs. 0 (0,0)). Group S had a higher rate of excellent anesthesia effect (77.9% vs. 56.8%) and anesthesia satisfaction (96.1% vs. 83%). Conclusion Drug withdrawal before anesthesia can significantly reduce the failure rate of epidural anesthesia and improve the anesthesia effect and anesthesia satisfaction in prolonged ELA conversion to ESA. Trial registration Chictr.org, ChiCTR2100047772. Registered on 26/6/2021.