Inadequate Neuraxial Anesthesia in Patients Undergoing Emergency Cesarean Delivery: A Qualitative and Quantitative Scoping Review

BACKGROUND: Neuraxial anesthesia is the preferred anesthetic technique for cesarean delivery, yet a systematic review found that 14% of blocks for elective cesarean delivery were inadequate. This scoping review aimed to explore patients' and anesthesiologists' experiences of inadequate neuraxial anesthesia during emergency cesarean delivery. Secondary objectives were to examine its definitions, management strategies, and reported prevalence. METHODS: A systematic literature search was conducted based on predefined inclusion criteria according to the PCC framework (Population, Concept, Context). Studies published since 1995 that reported clinical data were eligible. Three authors independently screened titles, abstracts, and full texts. Study quality was assessed using the Mixed Methods Appraisal Tool. RESULTS: The literature search yielded 6375 titles, of which 63 were included in the review. Data on patients' and anesthesiologists' experiences with inadequate neuraxial anesthesia during emergency cesarean delivery is very limited. Clinicians may experience difficulties identifying patients experiencing intraoperative pain. No common definition of "inadequate neuraxial block" was found. Intravenous opioids followed by S-Ketamine were the most common pharmacological strategies used for supplementation. Due to the varying definition of "inadequate block" no incidence could be calculated. CONCLUSION: Data on both patients' and anesthesiologists' experiences with inadequate neuraxial anesthesia during emergency cesarean delivery are sparse. Inadequate neuraxial anesthesia is inconsistently assessed, and with no consensus on its definition or management. A wide range of pharmacological strategies is used to avoid conversion to general anesthesia, but their effectiveness remains unclear. The reported incidence of inadequate neuraxial block ranges from 0% to 27%. EDITORIAL COMMENT: This scoping review presents an updated systematic review on how to better understand this kind of event, so that it could be better studied.