Citation: Regional Anesthesia and Pain Medicine. 2013, 38(5 SUPPL. 1), E155
Author: Airey N.; Singaravelu S.; Wankhade K.
Abstract: Purpose/Objective: Aim: Establish the RA to GA conversion rate at our institution and identify risk factors for its occurrence. There is unequivocal evidence that RA is safer than GA for patients undergoing CS and is also the preferred choice for patients. However, there are occasions when RA has to be converted to GA part way though the surgery. Materials and Methods: After seeking institutional audit department approval we conducted a retrospective review to identify all cases of RA to GA conversion in patients undergoing a CS over a 5 year period. Having identified the patients we then conducted a case note review. Outcome measures included; category of CS, time of operation, age of patient and reasons given for conversion. Results: 80 patients were identified as having had a RA to GA conversion. 30 patients having had a spinal initially (conversion rate of 1.08%) and 50 patients had an epidural top-up (9.38%). Of the 30 patients who received a spinal; 10 (0.69%) were elective and 20 (1.51%) had emergency CS. The conversion rate increased out-of-hours (18:00-08:00) for both epidural top-ups (10.25%) and spinals (1.61%). For patients <25 years the rate of conversion for epidural top-ups was 24% compared to 6% for patients >25 years. Conclusions: There is a significantly higher risk of RA to GA conversion in patients having an emergency CS, and those having a CS with an epidural top-up. Younger patients having an epidural top-up appear to be at very high risk of requiring a conversion to GA. These results question the wisdom of topping-up epidurals in patients <25 years.
