Abstract
Background: The addition of intrathecal fentanyl to spinal anesthesia for cesarean delivery has been shown to be beneficial, but its rate of utilization in the community setting is unknown. The primary aim of our study was to determine the rate of intrathecal fentanyl use for cesarean deliveries with spinal anesthesia in a community hospital, and our secondary aim was to determine its effect on anesthetic outcomes.Methods: Patients who underwent cesarean delivery from June 1, 2017 to November 30, 2019 with spinal anesthesia as the initial anesthetic technique were included.Results: Seven hundred sixty-one cesarean deliveries met inclusion criteria, and 161 (21.2%) patients received intrathecal fentanyl in their spinal anesthetic for cesarean delivery. A multivariate model that controlled for patient weight and time from spinal placement to procedure end showed that patients who received intrathecal fentanyl were less likely to have conversion to general anesthesia or administration of systemic anesthetic adjuncts compared to patients who did not receive intrathecal fentanyl (odds ratio 2.889, 95% CI 1.552-5.903; P=0.0017).Conclusion: Only 1 in 5 patients received intrathecal fentanyl for cesarean deliveries performed under spinal anesthesia in a community hospital despite known benefits. Patients who did not receive intrathecal fentanyl had increased odds of conversion to general anesthesia or administration of systemic anesthetic adjunct administration, a finding consistent with previous studies. The addition of intrathecal fentanyl to spinal anesthesia for cesarean delivery should be strongly considered in the community setting.
Highlights
Anesthesia for cesarean delivery is commonly performed with spinal anesthesia that consists of a local anesthetic such as bupivacaine, a short-acting opioid such as fentanyl, and a long-acting opioid such as morphine.[1]
The secondary aim was to determine if a difference in either conversion to general anesthesia or administration of systemic anesthetic adjunct administration was found between patients who did and did not receive intrathecal fentanyl for cesarean delivery
Some anesthesiologists and certified registered nurse anesthetists used a combined spinal epidural neuraxial kit to obtain spinal anesthesia, no epidural catheters were inserted into the epidural space
Summary
Anesthesia for cesarean delivery is commonly performed with spinal anesthesia that consists of a local anesthetic such as bupivacaine, a short-acting opioid such as fentanyl, and a long-acting opioid such as morphine.[1]. The primary aim of our study was to determine the rate of intrathecal fentanyl use in spinal anesthesia for cesarean delivery in a community setting. The secondary aim was to determine if a difference in either conversion to general anesthesia or administration of systemic anesthetic adjunct administration was found between patients who did and did not receive intrathecal fentanyl for cesarean delivery. The addition of intrathecal fentanyl to spinal anesthesia for cesarean delivery has been shown to be beneficial, but its rate of utilization in the community setting is unknown. The primary aim of our study was to determine the rate of intrathecal fentanyl use for cesarean deliveries with spinal anesthesia in a community hospital, and our secondary aim was to determine its effect on anesthetic outcomes. The addition of intrathecal fentanyl to spinal anesthesia for cesarean delivery should be strongly considered in the community setting
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