To the Editor:
The report by Katircioglu et al.1 describing the 0.35% (72 failures out of 20,572 patients) failure rate of epidural anesthesia for cesarean delivery agrees with our experience and is significantly less than failure rates (2.6%–13.1%) currently reported in the literature.2–5 Our unpublished review, also large and retrospective, encompassed 46,773 obstetrical patients from a single large metropolitan hospital over a 40-mo period (2001–2004). The definition of failed epidural anesthesia for both Katircioglu et al.’s and our reviews was the same, i.e., the need to convert from epidural anesthesia to general anesthesia. Patients undergoing cesarean delivery were divided into those receiving continuous epidural anesthesia for labor and who later underwent cesarean delivery under a converted epidural anesthetic, and those receiving primary epidural anesthesia for elective cesarean delivery.
Labor epidural anesthetics converted to cesarean delivery epidural anesthetics had a failure rate of 0.42%, whereas primary epidural anesthetics for elective cesarean delivery had a failure rate of 0.21%. Our overall combined results for epidural anesthesia were that 0.27% of epidural anesthetics for cesarean delivery failed, similar to the 0.35% reported by Katircioglu et al. We speculate that the experience of the anesthesiologists performing epidural anesthesia for obstetrical patients at our hospital and in the report by Katircioglu et al. (averaging >450 procedures per year per anesthesiologist) contributed to the failure rate being so much less than that reported in the literature. Perhaps the current reported failure rates of epidural anesthetics for cesarean delivery should be reexamined.
Robert P. S. Introna, MD
John R. Blair, MD
John B. Neeld, MD
Northside Anesthesiology Consultants, LLC
1. Katircioglu K, Hasegeli L, Ibrahimhakkioglu HF, Ulusoy B, Damar H. A retrospective review of 34,109 epidural anesthetics for obstetric and gynecologic procedures at a single private hospital in Turkey. Anesth Analg 2008;107:1742–5
2. Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuroaxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth 2004;13:227–33
3. Tortosa JC, Parry NS, Mercier FJ, Mazoit JX, Benhamou D. Efficacy of augmentation of epidural analgesia for caesarean section. Br J Anaesth 2003;91:532–5
4. Kinsella SM. A prospective audit of regional anaesthesia failure in 5080 caesarean sections. Anaesthesia 2008;63:822–33
5. Eappen S, Blinn A, Segal S. Incidence of epidural catheter replacement in parturients: a retrospective chart review. Int J Obstet Anesth 1998;7:220–5