Assessment of incidence and associated risk factors of complications of spinal anesthesia for c/s at jimma university medical center (jumc) from november 1, 2022 to december 30, 2022, jimma, south west Ethiopia

Abstract

Spinal anesthesia is a technique of introducing anesthetic drugs into the subarachnoid space to temporarily abolish the sensory and motor functions of several groups of spinal nerves. Spinal anesthesia recently has gained popularity for cesarean section. The change in attitude that has taken place is related to an increased awareness that regional block methods are safer for both mother and infant. Although SA is the most reliable type of regional block methods, the possibility of complications like hypotension, post-dural puncture headache, vomiting, shivering, total spinal and backache has long been recognized. Therefore this paper aims to bring out some complications and the management procedures necessary for safe cesarean section.1 Objective: To assess the incidence and associated risk factors of complications of spinal anesthesia for cesarean section at Jimma University Medical Center. Method: An institution-based cross-sectional study design was conducted on all eligible obstetric patients who came for cesarean section under spinal anesthesia from November 1, 2022, to December 30, 2022, at JUMC. The data collection method included a chart review and patient follow-up for three days of the postoperative period which was done by anesthesiology residents and anesthetists. Data was edited, coded, entered and cleaned by Epidata version 4.6.0.2 and analyzed by SPSS version 25. Both bivariable and multivariable logistic regression analyses were done to identify associated factors. The level of statistical significance was represented at p<0.05. Result In this study, among 162 patients for whom cesarean section was done under spinal anesthesia, 118(72.8%) developed intraoperative post-spinal complications. Shivering is the most common among post-spinal complications which occurred during intraoperative period and it is 50% that is statistically associated with hypotension (AOR = 0.137; 95%CI: (0.047–0.396)) and the use of intrathecal opioid (AOR=4.125; 95% CI: (1.376-12.366)). The incidence of hypotension is 43.8% which is statistically associated with large doses of local anesthetics (AOR=0.115; 95% CI: 0.032-0.412)) and use of adjuvant for spinal anesthesia (AOR=2.833; 95% CI: 1.004-7.997). In this study, the incidence of nausea and vomiting is 4.3% which is significantly associated with patients having intra-operative shivering (COR=12.5; 95% CI: 5.440-28.711) and who were not taking premedication (COR=7.748; 95% CI: 4.371-13.732).In this study, the incidence of failed spinal is 3.7% and there is strong association with failed spinal with higher body mass index >25kg/m2 (COR=14.333; 95% CI: (4.447-46.200).The incidence of bradycardia is 2.5% which is similar to a high spinal (2.5%) which has no identified risk factors in this study. Thirty-seven (22.8%) patients for whom cesarean section was done under spinal anesthesia developed postoperative complications after spinal anesthesia. Incidence of Post Dural puncture headache 20(12.3%) which is associated with large spinal needle size 22G (AOR=4.66; 95% CI:(0.827-26.342)) and 18(11.1%) developed back pain postoperatively and associated with larger spinal needle size(AOR=0.086;95% CI:0.007-1.088)). Conclusion Post-spinal complications are common in pregnant mothers for whom cesarean section was done after spinal anesthesia. The identified risk factors for complications, after spinal anesthesia, are hypotension, use of intrathecal opioids, large volume local anesthetics, repeated dural puncture, large spinal needle size, and anesthetist experience. Therefore, strict monitoring and vigilant management of these patients should be done prevent sequela and mortality.