2026 SOAP Annual Meeting

Epidural top-up rate of requiring intra-op adjuncts: ~13% 1

rate of conversion to GA: ~8%

Pain during CD remains a significant clinical issue

Prior data at our hospital: 4.3× higher adjunct-free anesthesia with catheter removal 2

Clinical dilemma: Top-up labor epidural vs replace epidural?

We hypothesized that removal of an indwelling labor epidural catheter would be independently associated with adjunct-free anesthesia for intrapartum cesarean deliveries (CD) compared to catheter top-up.

Retrospective chart review

Patients with indwelling labor epidural catheters who underwent intrapartum CD with attempted regional anesthesia between July 1, 2023 and June 30, 2025 at a single institution

Defined adjunct anesthetic medications as intraoperative administration of intravenous dexmedetomidine, fentanyl, ketamine, propofol, midazolam, inhaled nitrous oxide, or conversion to general anesthesia (GA)

Performed bivariate analysis between patients who did and did not have adjunct-free anesthesia.

Performed multivariate logistic regression with variables of interest to determine which patient and clinical characteristics were independently associated with adjunct-free anesthesia

Removal of an indwelling labor epidural catheter with subsequent placement of a new neuraxial technique before transition to CD is associated with 4x higher likelihood of adjunct-free anesthesia

Characteristics independently associated with adjunct-free during CD

physician-administered rescue analgesia boluses during labor

urgency of CD

operative time

Consider early catheter replacement when epidural performance is suboptimal

Future prospective patient-reported outcome studies are needed to evaluate the practice of removal of indwelling labor epidural catheters for CD.

2026 SOAP Annual Meeting

Management of indwelling labor epidural catheters for intrapartum cesarean delivery: a single-center retrospective study

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