Continuous Spinal Analgesia for Labor and Delivery: An Observational Study with a 23-Gauge Spinal Catheter.

BACKGROUND: The aim of the study was to assess postdural puncture headache, pain relief, motor blockade, and success rate of conversion to cesarean delivery anesthesia of a 23-gauge spinal catheter (Wiley Spinal®) for labor analgesia.

METHODS: After insertion of the spinal catheter, intrathecal bupivacaine 2.5 mg was administered, followed by patient-controlled intrathecal analgesia (basal infusion of 0.0625% bupivacaine with fentanyl 2 μg/mL at a rate of 2 mL/h, demand bolus 1 mL, lockout interval 20 minutes). Bupivacaine 0.5%, up to 25 mg, was administered via the catheter along with fentanyl 20 μg for cesarean delivery anesthesia, if necessary. The catheter was removed after delivery or after 12 hours, whichever was longer.

RESULTS: One hundred thirteen women were enrolled. In 12 women (11%), the catheter was not successfully inserted or maintained in position. Continuous spinal analgesia was used in 101 women. Three women (2.6%, 95% confidence interval, 0.7%-8.1%) developed postdural puncture headache. There were 83 spontaneous, 12 operative vaginal, and 18 cesarean deliveries. Of the 18 cesarean deliveries, 16 had continuous spinal analgesia when the decision was made to perform a cesarean delivery; conversion from labor analgesia to cesarean anesthesia was successful in 15 women (94%, 95% confidence interval, 67.7%-99.7%).

CONCLUSIONS: The 23-gauge spinal catheter can be used for analgesia for labor. It can also be converted to surgical anesthesia for cesarean deliveries. Further studies are warranted to determine whether the spinal catheter will be a useful addition to the neuraxial techniques available for obstetric anesthesia care.