Incidence and factors associated with failed spinal anaesthesia among patients undergoing surgery: a multi- center prospective observational study

Failed spinal anaesthesia causes prolonging of operation time, insufficient analgesia for surgery and needs repeating spinal anaesthesia which in turn causes local anaesthesia toxicity, high spinal and total spinal, and conversion to general anaesthesia. However, the problem remains unexplored in Amhara regional state comprehensive specialized hospitals.

To determine incidence and factors associated with failed spinal anaesthesia among patients undergoing surgery in selected Amhara National Regional State comprehensive specialized hospitals, Northwest Ethiopia, 2023.

Multi-center prospective observational study was conducted. Data was collected using questionnaire and checklist. All consecutive scheduled emergency and elective patients were included in the study. Data was transformed from Epi data to SPSS and logistic regression analysis was done. Both crude and adjusted odds ratio were used to assess the strength of association. Variables with a p-value of less than 0.05 were considered as statistically significant.

A total of 532 patients were included in this study with a response rate of 98%. Incidence of failed spinal anaesthesia was 22.4% (CI = 19-25.9). Emergency surgery (AOR = 7.01, CI = 4.5–12.7), dose of bupivacaine of ≤ 10 mg (AOR = 3.02, CI = 1.3–10.2), work experience of anaesthetist < 2 years (AOR = 3.1, CI = 1.7–5.72), bloody CSF (AOR = 8.5, CI = 2.53–18.5), hyperbaric local anaesthetic drug (AOR = 3.3, 95% CI = 3.2–8.2) and local anaesthetist without adjuvants (AOR = 5.25, CI = 2.62–14.2) were associated failed spinal anaesthesia.

The incidence of failed spinal anaesthesia was high in Amhara Region comprehensive specialized hospitals. We suggest that anaesthesia providers should minimize failure by using adjuvants and appropriate dose of local anaesthetic. Additionally, simulation training should be given for anaesthesia trainees to improve their skills and to produce competent professionals.