Conversion to General Anesthesia and Intravenous Supplementation During Intrapartum Cesarean Delivery With an Indwelling Epidural Catheter: A Retrospective Study

Abstract

( Reg Anesth Pain Med 2025;50:873–878. doi:10.1136/rapm-2024-105388) A retrospective cohort study examined the frequency and contributing factors associated with conversion from epidural anesthesia to general anesthesia (GA), as well as the use of intravenous analgesics or sedatives during intrapartum cesarean delivery (CD) in women with an existing labor epidural catheter. The research was conducted at a tertiary academic medical center (SOAP Center of Excellence) and included all eligible patients who underwent CD between January 2017 and June 2022. A standardized approach was provided for labor epidural analgesia, including up to 3 top-ups for breakthrough pain >4 on a verbal numeric scale and/or request for additional analgesia: (1) ropivacaine 0.1% 15 mL, (2) lidocaine 1% 10 mL, and (3) lidocaine 1% 10 mL + fentanyl 100 mcg. Following these three top-ups, if a VNS score of 4 or more persisted, the epidural catheter was replaced. This standardized algorithm sets this study apart, as it aimed to decrease catheter dysfunction as the indication for conversion to general anesthesia. To that end, the SOAP Center of Excellence criteria recommend a protocol for troubleshooting of epidural catheters and replacing catheters that are poorly functional.