Postpartum tubal ligation (PPTL) anesthesia: epidural reactivation or de novo spinal anesthesia

• High failure rates with both methods

• Optimal dose of intrathecal bupivacaine for PPTL unclear

• Recently using higher intrathecal bupivacaine doses and attempting epidural reactivation within 4 h of delivery

Aim: Inadequate blocks for PPTL with spinal anesthesia according to bupivacaine dose and with epidural reactivation

Hypothesis: Lower incidence of inadequate blocks with higher intrathecal bupivacaine dose

 

Methods:

Population

• PPTLs with epidural reactivation or de novo spinal anesthesia between 2003-2025

• Spinal anesthesia bupivacaine dose groups: low (7.5-9.75 mg), middle (10.5-12 mg), high (>13.5 mg)

Outcomes

• Inadequate block: need for IV analgesic/sedative supplementation (morphine, hydromorphone, propofol, ketamine, fentanyl>100µg , dexmedetomidine>20µg, midazolam>2mg) or failed block (repeat neuraxial block or conversion to general anesthesia)

Statistical Analysis

• Kruskal-Wallis test and Fisher's exact test

• Multivariable logistic regression for factors associated with inadequate blocks

 

Conclusion

• Higher bupivacaine doses (>13.5 mg) associated with significantly lower odds of inadequate blocks than middle doses (10.5-12 mg)

• Failure rate of epidural reactivation (13.0%) comparable to high dose spinal group (13.9%)

– Larger sample size needed to confirm these findings

• Higher rates of inadequate blocks in spinal anesthesia associated with:

– Fewer years since start of study

– Increased surgical duration

– Higher IT fentanyl doses