Spinal Anaesthesia Failure Risk Followed by Failed Epidural Block in Caesarean Deliveries

Background: There is a risk associated with spinal anaesthesia failure after immediate deliverance of epidural anaesthesia. Objective: To assess the risk of spinal anaesthesia failure followed by failed epidural block in caesarean deliveries. Study Design: Retrospective study Place and Duration of Study: Department of Obstetrics & Gynaecology, Khairpur Medical College Khairpur Mir’s from 1st July 2020 to 30th June 2021. Methodology: One hundred and seventy labour cases who have been given epidural anaesthesia and were prepared for caesarean section through spinal anaesthesia were included. The demographic and clinical information of each pregnant female was documented. Proper epidural dosage was maintained during labour. Results: The mean age of the patients was 26.5±5.2 years. There was a significant increase in body mass index among epidural converted spinal aesthesia patients. The higher incidence of non-reassuring foetal heart tracing and malpresentation in failure cases were found. Conclusion: There is a 11.17% risk of spinal anaesthetics failure for attaining block height when administered within 30 min of epidural dose. Keywords: Epidural, Spinal anaesthesia, Anaesthesia, Caesarean

Rare Cases of Bilateral Lumbar Hernia: Anaesthesia Concerns and Lessons Learnt

Bilateral lumbar hernias are rare. There is a paucity of literature regarding the anaesthesia techniques used and challenges faced. In the present era of minimally invasive surgery, laparoscopy has gained name and fame and is the modality of choice for hernia repairs. Methods: We report a series of 4 cases of bilateral lumbar hernia operated in our institute, using 4 different anaesthesia techniques over a period of 2 years and 9 months with the aim to focus on the varied anaesthetic techniques and the advantages and disadvantages of each. Results: General anaesthesia supplemented with epidural anaesthesia is recommended for laparoscopic repair, while in very high risk cases, combined segmental spinal- epidural anaesthesia may be a better option. Low dose segmental spinal provides commendable cardiovascular stability. It is a useful alternative in patients with multiple comorbidities, cardiac and respiratory diseases and aids early recovery and ambulation. Conclusion: Irrespective of the type of anaesthesia technique administered, patients’ safety and comfort should be of prime importance, while maintaining optimum haemodynamics and physiology.