(Can J Anaesth. 2016;63(10):1170–1178)
A retrospective cohort study was conducted with the aim to investigate factors that are associated with failed and high spinal blocks in patients who received spinal anesthesia for cesarean delivery following insufficient surgical anesthesia from a labor epidural that had been appropriately topped up. The study also assessed the incidence of high spinal blocks in this setting. Data from the Duke Perioperative Anesthesia Database were retrospectively retrieved for women in labor with an existing labor epidural who required a cesarean delivery and received either single-shot spinal or combined spinal-epidural (CSE) anesthesia due to inadequacy of the labor epidural to provide surgical anesthesia, either after a top up for cesarean delivery or without receipt of a top-up dose. The occurrence of failed spinal blocks was the primary outcome of the analysis and the occurrence of high blocks following spinal administration was the secondary outcome.