Epidural analgesia in the obese obstetric patient: a retrospective and comparative study with non-obese patients at a tertiary hospital
Analgesia peridural em paciente obstétrica obesa: estudo retrospectivo e comparativo com pacientes não obesas em hospital terciário
Claudia Cuesta González-Tascón, Elena Gredilla Díaz, Itsaso Losantos García
Abstract
Background and objectives
Obesity is becoming a frequent condition among obstetric patients. A high body mass index (BMI) has been closely related to a higher difficulty to perform the neuraxial technique and to the failure of epidural analgesia. Our study is aimed at analyzing obese obstetric patients who received neuraxial analgesia for labor at a tertiary hospital and assessing aspects related to the technique and its success.
Methods
Retrospective observational descriptive study during one year. Women with a BMI higher than 30 were identified, and variables related to the difficulty and complications of performing the technique, and to analgesia failure rate were assessed.
Results and conclusions
Out of 3653 patients, 27.4% had their BMI ≥ 30 kg.m-². Neuraxial techniques are difficult to be performed in obese obstetric patients, as showed by the number of puncture attempts (≥ 3 in 9.1% obese versus 5.3% in non-obese being p < 0.001), but the incidence of complications, as hematic puncture (6.6%) and accidental dural puncture (0.7%) seems to be similar in both obese and non-obese patients. The incidence of cesarean section in obese patients was 23.4% (p < 0.001). Thus, an early performance of epidural analgesia turns out to be essential to control labor pain and to avoid a general anesthesia in such high-risk patients.
Keywords
References
1 Instituto Nacional de Estadística (INE). Índice de masa corporal según grupos de edad (% población de 18 y más años), recuperado de: http://www.ine.es.
2 E. Riveros-Perez, J. McClendon, J. Xiong, et al. Anesthetic and obstetric outcomes in pregnant women undergoing cesarean delivery according to body mass index: Retrospective analysis of a single-center experience Ann Med Surg., 36 (2018), pp. 129-134
3 E.A. Sullivan, J.E. Dickinson, G.A. Vaughan, et al. and on behalf of the Australasian Maternity Outcomes Surveillance System (AMOSS) – Maternal super-obesity and perinatal postcomes in Australia: a national population-based cohort study. Sullivan et al BMC Pregnancy Childbirth., 15 (2015), p. 322
4 A.O. Kula, M.L. Riess, E.H. Ellinas Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients J Clin Anesth., 37 (2017), pp. 154-158
5 P.M. Catalano, K. Shankar Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child BMJ., 360 (2017), p. j1
6 J.M.G. Crane, P. Murphy, L. Burrage, et al. Maternal and perinatal outcomes of extreme obesity in pregnancy J Obstet Gynaecol Can., 35 (2013), pp. 606-611
7 A. Tonidandel, J. Booth, R. D’Angelo, et al. Anesthetic and Obstetric outcomes in morbidly obese parturients: a 20-year follow-up retrospective cohort study Int J Obstet Anesth., 23 (2014), pp. 357-364
8 E. Guasch, F. Iannuccelli, N. Brogly, et al. Failed epidural for labor: what now? Minerva Anestesiol., 83 (2017), pp. 1207-1213
9 E. Guasch, R. Ortega, F. Gilsanz Analgesia epidural para parto en la gestante obesa Rev Soc Esp Dolor., 13 (2006), pp. 468-474
10 V.A. Eley, A. Chin, R. Sekar, et al. Increasing body mass index and abdominal subcutaneous fat thickness are associated with increased skin-to-epidural space distance in pregnant women Int J Obstet Anesth., 38 (2019), pp. 59-65
11 C.Y. Espinoza-Hernández, M.S. Estrada-Utrera, F.G. Islas-Ruíz, et al. Técnica de Nesi para identificación del espacio epidural vs técnica de Pitkin en cirugía obstétrica Anest Méx., 28 (2016), pp. 11-18
12 T. Sahin, O. Balaban, L. Sahin, et al. A randomized controlled trial of preinsertion ultrasound guiadance for spinal anesthesia in pregnancy: Outcomes among obese and lean parturients: Ultrasound for spinal anesthesia in pregnancy J Anesth., 28 (2014), pp. 413-419
13 M. Li, X. Ni, Z. Xu, et al. Ultrasound-assisted technology versus the conventional landmark location method in spinal anesthesia for cesarean delivery in obese parturients: A randomized controlled trial Anesth Anal., 129 (2019), pp. 155-161
14 M.M. Tawfik, M.M. Atallah, W.S. Elkharboutly, et al. Does preprocedural ultrasound increase the first-pass success rate of epidural catheterization before cesarean delivery? A randomized controlled trial Anesth Analg., 124 (2017), pp. 851-856
15 E. Gredilla, A. Pérez Ferrer, E. Canser, et al. Factores asociados a la satisfacción materna con analgesia epidural para control del dolor del trabajo de parto Med Prevén., 14 (2008), pp. 22-27
16 F. Peralta, N. Higgins, E. Lange, et al. The relationship of body mass index with the incidence of postdural puncture headache in parturients Anesth Analg., 121 (2015), pp. 451-456
17 M. Miu, M.J. Paech, E. Nathan The relationship between body mass index and post-dural puncture headache in obstetric patients Int J Obstet Anesth., 23 (2014), pp. 371-375
18 X. An, Y. Zhao, Y. Zhang, et al. Risk assessment of morbidly obese parturient in cesarean section delivery. A prospective cohort, single-center study Medicine., 96 (2017), p. 42
19 T. López Correa, J.C. Garzón Sánchez, F.J. Sánchez Montero, et al. Cefalea postpunción dural en obstetricia Rev Esp Anestesiol Reanim., 58 (2011), pp. 563-573
20 E. Anne MacGregor Headache in pregnancy Neurol Clinics., 30 (2012), pp. 835-866
21 A.M. Franz, S.Y. Jia, H.T. Bahnson, et al. The effect of second-stage pushing and body mass index on postdural puncture headache J Clin Anesth., 37 (2017), pp. 77-81
22 J. Song, T. Zhang, A. Choy, et al. Impact of obesity on postdural puncture headache Int J Obstet Anesth., 30 (2017), pp. 5-9
23 K. Saravanakumar, S.G. Rao, G.M. Cooper Obesity and obstetric anaesthesia Anaesthesia., 61 (2006), pp. 36-48
24 A. Brick, R. Layte, A. McKeating, et al. Does maternal obesity explain trends in caesarean section rates? Evidence from a large Irish maternity hospital Ir J Med Sci., 189 (2020), pp. 571-579
25 C.R. Taylor, J.E. Dominguez, A.S. Habib Obesity and Obstetric Anesthesia: current insights Local Reg Anesth., 12 (2019), pp. 111-124
26 S.J. McCall, Z. Li, J.J. Kurinczuk, et al. Maternal and perinatal outcomes in pregnant women with BMI & 50: An international collaborative study PLoS ONE., 14 (2019), Article e0211278
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