A prospective, observational audit of failed regional anaesthesia in 4085 caesarean sections at a tertiary care hospital

Introduction: A prospective observational study was conducted in 4085 caesarean sections performed under Regional anaesthesia (RA) from February 2014 to January 2017 in tertiary care centre. The incidence and various contributing factors leading to total or partial failure of RA and the conversion rate to GA were determined. Materials and Methods: All parturients posted for elective or emergency caesarean section received 10-12 mg 0.5% of hyperbaric bupivacaine added to 25 µg of inj. Fentanyl, administered through a 25-27G Whitacre needle. A structured proforma was prepared to note the demographic data, type of RA, insertion position, position after insertion, local anesthetic volume, loss of sensation to pin prick and grade of motor block. Results: In this 3 year period 4085 CS were performed, out of which 4054 (99.27%) were conducted under RA, [4034 (99.5%) under spinal anesthesia, 14 (0.34%) under CSE and 6 (0.14%) under epidural]. 30 (0.73%) cases received GA primarily, the incidence of conversion rate from neuroaxial anesthesia to GA was 100 (2.5%) out of which 1.77% were of elective surgery and 3.1% were in emergency surgery. Partial failure occurred in 1.68% and complete failure in 0.79% patients. Spinal failure occurred due to anesthetic factors like early start of surgery, before establishment of adequate block, inadequate dose of LA, inappropriate recording of block, ineffective batch of drug and technical or surgical factors. Conclusion: Minimizing the incidence of block failure requires close attention to minute details.