Delivery room local infiltration anesthesia with non-intubated general anesthesia for category Ⅰ cesarean section: shorter decision-to-delivery interval but no improvement in maternal or neonatal outcomes – a retrospective cohort study

To compare maternal and neonatal outcomes between local infiltration anesthesia combined with non-intubated general anesthesia in the delivery room versus tracheal intubation general anesthesia in the operating room for category I cesarean section. This single-center retrospective cohort study included 88 women undergoing Category I cesarean Sects. (2021–2025), stratified into local anesthesia group (delivery room, n = 23) and general anesthesia group (operating room, n = 65). Multivariate regression adjusted for age, BMI, parity, preoperative hemoglobin/white blood cell count, gestational age, and incision type. The local anesthesia group had significantly shorter median decision-to-delivery interval (DDI) [9.0 (IQR 7.0–9.0) vs. 26.0 (18.0–40.0) minutes, P < 0.001]; after adjustment, anesthesia technique independently predicted DDI, with the GA group having a significantly longer DDI than the LA group (β = 17.96, 95% CI: 7.42–28.51, P = 0.001). However, the LA group had longer operative duration [68.0 (61.5–78.5) vs. 51.0 (43.0–67.0) min, P < 0.001], greater estimated blood loss [400 (400–500) vs. 400 (300–400) mL, P = 0.028], and a higher rate of vertical incisions (69.57% vs. 10.77%, P < 0.001). After multivariable adjustment, anesthesia technique was not independently associated with blood loss ( P = 0.631), operative duration ( P = 0.126), Δhemoglobin ( P = 0.440), or postoperative WBC count ( P = 0.495). Neonatal outcomes were comparable, with no significant differences in the incidence of low 1-minute Apgar scores (30.43% vs. 29.23%, P = 0.913; adjusted OR = 1.589, 95% CI: 0.358–7.06, P = 0.543) or postoperative fever (21.74% vs. 9.38%, P = 0.244). While this rescue strategy of delivery-room local infiltration combined with non-intubated general anesthesia significantly shortened DDI in extreme emergencies, it did not translate into improved maternal or neonatal outcomes in this exploratory cohort. Given the inherent risks of aspiration and airway compromise, this approach is not recommended for routine use and should be restricted to exceptional circumstances where standard anesthesia is immediately unavailable. These findings are hypothesis-generating and require cautious interpretation.