Outcomes
PDPH, hand weakness, pain, pruritus, headache, accidental dural puncture, nausea, vomiting
ADVERSE EVENTS, EVENT, LOCAL ANESTHETIC SYSTEMIC TOXICITY, SECONDARY
The primary outcome was the onset time to surgical anesthesia. This was defined as the start of epidural extension anesthesia (time zero on the stopwatch) to when the patient could no longer feel sharp sensation at T6 (assessed bilaterally at the midclavicular line).Secondary outcomes included the quality of epidural anesthesia. This was a composite of the following factors: (1) failure to achieve a T10 bilateral block preoperatively (after epidural administration of 3 mL of 1.5% lidocaine with 1:200 000 epinephrine and up to 20 mL of 0.0625% bupivacaine with 2 µg/mL fentanyl), (2) failure to achieve a surgical block within 15 minutes of epidural extension anesthesia, (3) the requirement for intraoperative analgesia supplementation, (4) requirement for repeat neuraxial procedure, or (5) conversion to general anesthesia. The intraoperative analgesia supplementation rate was defined as the requirement for any rescue medication to control discomfort or pain during cesarean delivery. The choice of medication was at the clinical discretion of the anesthesiologist. All components of the composite outcome were treated as binary measures, and the presence of any event was considered positive for the secondary outcome (collapsed composite).Other secondary outcomes included maternal satisfaction and pain score during surgery (assessed in recovery room, where 0 indicates very dissatisfied and 10 indicates very satisfied), opioid consumption in the first 24 hours, adverse events (eg, self-reporting of nausea, vomiting, or pruritus), timings (from primary outcome to start of surgery and duration of surgery), maternal vasopressor requirements (intraoperative dose administered), epidural block assessments, neonatal outcomes (Apgar score at 1 and 5 minutes and the umbilical cord blood gasses), and other adverse events, including local anesthetic systemic toxicity, accidental dural puncture (ADP), high spinal (ie, exaggerated cranial spread of spinal anesthesia leading to hand weakness, difficulties breathing, and, finally, unconsciousness), and postdural puncture headache (PDPH) assessed on postpartum day 1.