Association of patient and clinical characteristics with failed conversion of neuraxial anesthesia for intrapartum cesarean delivery among patients who had top-up of indwelling labor epidural catheters: a retrospective single center study

Background The primary aim of our study was to determine which patient and clinical characteristics were associated with failed conversion from neuraxial labor analgesia to neuraxial anesthesia for intrapartum cesarean delivery (CD) at our hospital.Methods The study included patients who had a CD between July 1, 2019, and December 31, 2023, and had attempted conversion from neuraxial labor analgesia to neuraxial anesthesia for intrapartum CD by top-up of an indwelling labor epidural catheter. We performed a bivariate analysis comparing patients who did and did not have neuraxial anesthesia conversion failure along with a multivariate logistic regression to determine which variables were associated with neuraxial anesthesia conversion failure.Results Among the 455 patients in the final analysis, 70 (15%) had neuraxial anesthesia conversion failure. A multivariate logistic regression found that replacement of the epidural catheter during labor (adjusted odds ratio [aOR] 3.03, 95% confidence interval [CI] 1.13–8.12; P = 0.03) and emergency obstetric indication for CD (aOR 5.14, 95% CI 2.25–11.72; P < 0.01) were associated with neuraxial anesthesia conversion failure.Discussion Replacement of an epidural catheter during labor and emergency indication for CD were both independently associated with neuraxial anesthesia conversion failure among patients who had top-up of their indwelling labor epidural catheter.