2026 SOAP Annual Meeting

A retrospective analysis of neuraxial anesthesia failures for post-partum tubal ligation procedures: Could umbilical sparing be to blame?

Background:

Postpartum tubal ligation (PPTL) is one of the most common forms of contraception in the USA

Neuraxial anesthesia failure rates are higher in PPTL than cesarean delivery -> etiology unknown

Umbilical sparing: residual periumbilical sensation

Aims:

To evaluate anesthetic failures for patients undergoing PPTL and measure the potential implications of umbilical sparing

Methods:

A priori sub-analysisof single-center retrospective cohort study

Inclusion: PPTL during same admission as vaginal delivery (2013-2023)

Exclusion: PPTL with concurrent cesarean delivery; interval PPTL

Primary outcome

Rate of umbilical sparing

Rate of anesthetic failure due to umbilical sparing

Results:

363 patients underwent PPTL

69(19%) patients with failed anesthesia

40 (11%) patients had umbilical sparing

19 (47.5%) had anesthesia failure due to umbilical sparing

Discussion:

Umbilical sparing occurs in 11% of all PPTL patients

Umbilical sparing is implicated in 28% of neuraxial anesthesia failures

53% of patients with umbilical sparing underwent successful PPTL after periumbilical lidocaine infiltration

Limitations:

Retrospective data may underestimate rate of umbilical sparing

Mechanism of umbilical sparing?

Future directions:

Prospective evaluation of potential explanatory variables:

Umbilical sparing rates

Standardization of periumbilical local anesthesia

Embryologic research on umbilical innervation

A retrospective analysis of neuraxial anesthesia failures for postpartum tubal ligation procedures: could umbilical sparing be to blame?