Study Reveals Need to Standardize Anesthesia During Elective Cesarean Delivery

Originally published by our sister publication Anesthesiology News

An observational study at British Columbia Women’s Hospital and Health Centre, in Vancouver, found that the institution’s current clinical practice during elective cesarean delivery under spinal anesthesia did not align with the 2022 guidelines of the Obstetric Anaesthetists’ Association (OAA).

The guidelines recommend using light touch as the primary modality and achieving at least a T5 sensory block to minimize the risk for intraoperative pain. However, less than half of the 14 consultants used light touch and only two aimed for the T5 level, neither of which correctly identified the T5 dermatome. Additionally, less than one-third of all consultants marked the T5 dermatome accurately on a standardized diagram, according to the research presented at the 2024 annual meeting of the Canadian Anesthesiologists’ Society (abstract 62).

Spinal block assessments used various combinations of modalities. Most consultants used pinprick and ice (seven; 50%) or light touch and ice (five; 36%), with only one who used light touch, pinprick and ice (7%) or ice alone (7%). Among the six consultants using light touch, assessment tools consisted of a cotton ball (three; 50%), gauze (two; 33%) and a neurologic exam pin (one; 17%).

“Many centers rely solely on dermatome testing with ice, which misses the beta pain fibers and does not fully assess block density. Light touch is essential for evaluating these fibers and obtaining critical information,” said study author Juliana Barrera, MD, a staff anesthesiologist at BC Women’s Hospital.

Although no patients required additional IV analgesia, Barrera said this is largely because they use a higher dosage than that typically used in most centers (bupivacaine 0.75% or 1.8 mL). “The observed variability in these specialized settings underscores the potential for even greater variability and increased intraoperative pain in community centers where lower doses are common, and accurately determining block level and density is crucial,” she noted.

According to Barrera, the significant variability presents opportunities to standardize anesthesia practices in accordance with OAA guidelines. It is her hope to integrate a diagram into the OR for easy cross-checking of dermatome levels, as well as her hospital’s anesthesia system, to enhance the precision of documenting dermatomal levels.

“This initiative would be especially beneficial for follow-up cases. For instance, if a subsequent C-section is performed on the same patient, having access to a clear diagram from previous procedures would help us understand the effectiveness of the block,” Barrera concluded. “I truly think that better standardization of how we test and document things could help us decrease the incidence of intraoperative pain.”

By Norah Chinn

Barrera reported no relevant financial disclosures. The study won the meeting Award for Best Abstract in Obstetric Anesthesia.