Inadequate neuraxial anesthesia during cesarean delivery: incidence and predictors in a large retrospective contemporary cohort
- 1epartment of Anesthesiology, Faculty of Medicine, Lokman Hekim University, Ankara, Türkiye
Abstract
ObjectiveSpinal anesthesia is the preferred anesthetic technique for cesarean delivery because of its favorable maternal and neonatal safety profile. Despite its widespread use, inadequate neuraxial anesthesia remains an important clinical problem that may result in intraoperative pain, supplemental pain relief, or conversion to general anesthesia. Previous studies have shown inconsistent incidence rates and unreliable predictors of failed spinal anesthesia. This study aimed to determine the incidence of inadequate spinal anesthesia during cesarean delivery and to identify patient- and procedure-related factors associated with block inadequacy.MethodsThis retrospective cohort study included all adult patients who underwent cesarean delivery under planned spinal anesthesia at a tertiary university hospital between January 2020 and January 2026. Inadequate spinal anesthesia was defined as the combination of partial and total failure of spinal block. Demographic, obstetric, anesthetic, and surgical variables were evaluated. Multivariable logistic regression analysis was performed to identify independent predictors of inadequate spinal anesthesia.ResultsA total of 3,382 cesarean deliveries performed under spinal anesthesia were analyzed. Adequate spinal anesthesia was achieved in 3,216 patients (95.1%). Inadequate spinal anesthesia occurred in 166 patients (4.9%), including 135 partial failures (4.0%) and 31 total failures (0.9%). Increasing age and higher educational level were associated with lower odds of inadequate spinal anesthesia, whereas postpartum sterilization and surgical adhesions were independently associated with higher odds of inadequate spinal anesthesia.ConclusionsAlthough spinal anesthesia provided effective surgical anesthesia in the vast majority of cesarean deliveries, inadequate neuraxial block remained clinically relevant. Both patient-related and surgical factors were associated with an increased risk of block inadequacy. Identification of high-risk patients may facilitate individualized anesthetic planning and improve maternal intraoperative experience.
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BibTeX
@article{demir2026inadequate,
title = {{Inadequate neuraxial anesthesia during cesarean delivery: incidence and predictors in a large retrospective contemporary cohort}},
author = {Orhun Demir and Omer Zuhtu Yondem and Baris Ecevit Yuksel},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1930644},
url = {https://doi.org/10.3389/fmed.2026.1930644},
note = {CC BY},
}
RIS
TY - JOUR
TI - Inadequate neuraxial anesthesia during cesarean delivery: incidence and predictors in a large retrospective contemporary cohort
AU - Orhun Demir
AU - Omer Zuhtu Yondem
AU - Baris Ecevit Yuksel
PY - 2026
DA - 2026/10/26
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1930644
UR - https://doi.org/10.3389/fmed.2026.1930644
AB - ObjectiveSpinal anesthesia is the preferred anesthetic technique for cesarean delivery because of its favorable maternal and neonatal safety profile. Despite its widespread use, inadequate neuraxial anesthesia remains an important clinical problem that may result in intraoperative pain, supplemental pain relief, or conversion to general anesthesia. Previous studies have shown inconsistent incidence rates and unreliable predictors of failed spinal anesthesia. This study aimed to determine the incidence of inadequate spinal anesthesia during cesarean delivery and to identify patient- and procedure-related factors associated with block inadequacy.MethodsThis retrospective cohort study included all adult patients who underwent cesarean delivery under planned spinal anesthesia at a tertiary university hospital between January 2020 and January 2026. Inadequate spinal anesthesia was defined as the combination of partial and total failure of spinal block. Demographic, obstetric, anesthetic, and surgical variables were evaluated. Multivariable logistic regression analysis was performed to identify independent predictors of inadequate spinal anesthesia.ResultsA total of 3,382 cesarean deliveries performed under spinal anesthesia were analyzed. Adequate spinal anesthesia was achieved in 3,216 patients (95.1%). Inadequate spinal anesthesia occurred in 166 patients (4.9%), including 135 partial failures (4.0%) and 31 total failures (0.9%). Increasing age and higher educational level were associated with lower odds of inadequate spinal anesthesia, whereas postpartum sterilization and surgical adhesions were independently associated with higher odds of inadequate spinal anesthesia.ConclusionsAlthough spinal anesthesia provided effective surgical anesthesia in the vast majority of cesarean deliveries, inadequate neuraxial block remained clinically relevant. Both patient-related and surgical factors were associated with an increased risk of block inadequacy. Identification of high-risk patients may facilitate individualized anesthetic planning and improve maternal intraoperative experience.
SN - 2296-858X
ER -