Neuraxial anesthetic failures for postpartum tubal ligation after vaginal delivery: a single center retrospective cohort study (2013-2023).

BACKGROUND

Postpartum tubal ligation procedures have high anesthetic failure rates. The objective of this study was to compare our institution's failure rates to previous studies.

METHODS

This retrospective single-center study analyzed patients undergoing tubal ligation after vaginal delivery from 2013 to 2023, comparing successful and failed neuraxial anesthetics. The primary outcome was the failed neuraxial anesthesia rate, defined as performance of a second neuraxial procedure, administration of moderate-to-deep sedation, or conversion to general anesthesia.

RESULTS

Of 363 patients, there were 294 (81.0%) successful neuraxial anesthetics and 69 (19%) failures. Amongst successes, 39 (10.7%) were de novo spinal anesthetics, and 255 (70.3%) were labor epidural catheter reactivations. There were no statistical differences in failure rates between modes of anesthesia (18.3% with reactivation of in situ labor epidural catheter vs. 23.5% with de novo spinal anesthesia; P = 0.44). The most common clinical scenario for a neuraxial anesthetic to have qualified as a failure was administration of moderate-to-deep sedation in 41 of 69 cases of failure (59.4%), followed by neuraxial replacement in 20 cases (29.0%) The overall conversion rate to general anesthesia in this cohort was 2.8% (10/363).

CONCLUSIONS

Neuraxial anesthesia failure rates were similar to previously described rates of failure, with no difference between spinal anesthetics and labor epidural catheter reactivations. Sedation administration was the most common reason for defining a failed neuraxial anesthetic in this cohort, with few conversions to general anesthesia overall. Standardized definitions of neuraxial anesthesia failure and intended vs. unintended sedation administration for postpartum tubal ligation are warranted to further report failure rates and characterize why failures occur.