Abstract

Spinal anesthesia is often considered the gold standard for anesthesia in cesarean delivery. However, many women undergoing cesarean delivery may already have an epidural placed during labor. Additional local anesthetic in a higher concentration can be delivered to top up an epidural to provide anesthesia for cesarean delivery; however, they still do not provide the same dense block obtained with a spinal anesthetic. Up to 11.9% of parturients complain of pain during cesarean delivery with an epidural. This risk of an inadequate epidural is increased in patients who require bolus dosing through the epidural during labor or those with an epidural in place for >8 hours. Unplanned administration of intravenous adjuncts to mitigate intraoperative pain and anxiety is reported in approximately 31.5% of patients. These medications can affect the parturient’s mental status and memory of delivery. Anesthetists often fear the complication of a high spinal if they choose to place one behind an inadequate epidural. However, the risk of a high spinal is a rare complication with varying rates reported, but estimated at 1 in 4336 cases. Risks to the mother and neonate from conversion of a poor surgical epidural to a general anesthetic are greater than the minimal risk of a high spinal block. Anesthesia providers can decrease intraoperative pain and anxiety while keeping the parturient and neonate safe during cesarean delivery by converting marginal epidurals to spinal anesthesia before surgery. Evidence supports a decreased intrathecal dose of 8 mg isobaric ropivacaine or 8-10 mg of hyperbaric bupivacaine following epidural discontinuation to reach an anesthetic level of T6 after 5 minutes.

Author Details

Grace M. Redden, DNP(c), BSN, CCRN, SRNA; Maria D. Ledbetter, DNAP, CRNA, CNE

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Cesarean Section, Epidural Anesthesia, Cesarean Section Complications, Neuraxial Anesthesia, Cesarean Delivery, Failed Epidural Conversion

Advisor

Terri M. Cahoon

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-03-18

Full Text of Presentation

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Additional Files

Abstract.pdf (163 kB)

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