Regional Anesthesia Complications Correlated With Morbid Obesity [34F]

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Maternal obesity increases anesthesia complication at Cesarean Delivery(CD). We sought to evaluate the contribution of technical factors to anesthesia complications during scheduled CD.


All patients undergoing scheduled CD under spinal anesthesia at 37-41 weeks from 2015-2017 were included. Exclusion criteria included planned general anesthesia. Primary outcome was total spinal procedure time. Secondary outcomes: number of spinal placement attempts, spinal needle > 3.5 inches, failed placement of spinal with conversion to general anesthesia, high spinal blockade, and additional intravenous analgesics.


Of 575 included patients, 131 (23%) had BMI <30 kg/m2 (Group I), 275 (48%) had BMI 30.0-39.9 kg/m2 (Group II), and 169 (29%) had BMI > 40.0 kg/m2 (Group III). Total spinal time increased with BMI (I:5±4 min, II:6±9 min, III:8±7 min, P < .01). More than 1 spinal placement attempt was more frequent among obese patients [I:7/122 (6%), II:27/248 (11%), III:36/157 (23%), P < .001], as was needle length > 3.5 cm [I:2/122 (2%) vs. II:13/238(6%), III:39/158(25%), P = .04]. More obese patients required additional intravenous analgesics [I:12(9%), II: 31(11%), III:20(12%), P = .03] to complete the surgery. Failed placement of spinal with conversion to general (n = 3,2,2, P = 1) and high spinal blockade (n = 0,2,2, P = 1) were both uncommon and similar between groups.


Although spinal anesthesia placement was more complicated among obese patients, the incidence of serious anesthesia complications remained low. Spinal anesthesia remains an acceptable choice for scheduled CD in obese patients.

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