Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intra-operative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; prevalence of conversion from neuraxial anaesthesia to general anaesthesia following inadequate neuraxial anaesthesia; and the effect of mode of anaesthesia. We searched studies reporting inadequate neuraxial anaesthesia that used ≥ ED95 doses (effective dose in 95% of the population) of neuraxial local anaesthetic agents. Our primary outcome was the prevalence of inadequate neuraxial anaesthesia, defined as the need to convert to general anaesthesia; the need to repeat or abandon a planned primary neuraxial technique following incision; unplanned administration of intra-operative analgesia (excluding sedatives); or unplanned epidural drug supplementation. Fifty-four randomised controlled trials were included (3497 patients). The overall prevalence of requirement for supplemental analgesia or anaesthesia was 14.6% (95%CI 13.3–15.9%); 510 out of 3497 patients. The prevalence of general anaesthesia conversion was 2 out of 3497 patients (0.06% (95%CI 0.0–0.2%)). Spinal/combined spinal–epidural anaesthesia was associated with a lower overall prevalence of inadequate neuraxial anaesthesia than epidural anaesthesia (10.2% (95%CI 9.0–11.4%), 278 out of 2732 patients vs. 30.3% (95%CI 26.5–34.5%), 232 out of 765 patients). Further studies are needed to identify risk factors, optimise detection and management strategies and to determine long-term effects of inadequate neuraxial anaesthesia.

中文翻译：

---

择期剖腹产患者的椎管内麻醉不充分：一项系统评价

椎管内麻醉广泛用于择期剖腹产手术，但术中麻醉不足的普遍性尚不清楚。我们的目的是确定择期剖宫产术中椎管内麻醉不充分的发生率；在椎管内麻醉不充分后从椎管内麻醉转为全身麻醉的流行率；以及麻醉方式的影响。我们检索了报告椎管内麻醉不充分的研究，这些研究使用了≥ ED95 剂量（95% 的人群有效剂量）的椎管内局部麻醉剂。我们的主要结果是椎管内麻醉不充分的发生率，定义为需要转为全身麻醉；切开后需要重复或放弃计划的主要椎管内技术；计划外的术中镇痛（不包括镇静剂）；或计划外的硬膜外药物补充。纳入了 54 项随机对照试验（3497 名患者）。需要补充镇痛或麻醉的总体患病率为 14.6% (95%CI 13.3–15.9%)；3497 名患者中的 510 名。在 3497 名患者中，全身麻醉转换的发生率为 2 例 (0.06% (95%CI 0.0–0.2%))。与硬膜外麻醉相比，腰麻/腰硬联合麻醉与椎管内麻醉不充分的总体患病率较低有关 (10.2% (95%CI 9.0–11.4%)，2732 名患者中有 278 名 vs. 30.3% (95%CI 26.5–34.5) %), 765 名患者中有 232 名)。需要进一步的研究来确定危险因素，优化检测和管理策略，并确定不充分的椎管内麻醉的长期影响。