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2026, Vol: 10, Issue: 1
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Review Article
Online Published: 22 Nov 2025
 


Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting

Mazi Mohammed Alanazi, Ahmed Mohamed Hassan, Nedaa Ahmed Zamzamy, Fatimah Abdullah Alharbi, Shahad Hamdan Alsulami, Hifaa Ahmed Zamzamy, Khalid Mohammed Aljaber, Mohammed Abdulhavidh Alzhrany, Ashwaq Naif Alosaimi, Faris Abdulhavidh Alzhrany.


Abstract
This systematic review aimed to compare the effectiveness of spinal anesthesia versus extending an existing labor epidural for urgent intrapartum cesarean deliveries. A systematic review of nine studies (one randomized trial, eight observational) was conducted including Europe, Asia, and North America. Primary outcomes were conversion to general anesthesia (GA) and analgesic failure. Secondary outcomes included timing metrics, maternal hemodynamics, and neonatal indices. It was found that GA conversion after attempted epidural activation ranged from 3.4% to 21%, varying by urgency and catheter quality. The single randomized trial found that spinal anesthesia provided a safer surgical block than epidural activation (block failure 2.5% vs 15.3%) and required fewer analgesic rescue interventions (1.3% vs 12.9%), with similar Apgar scores. While one cohort found switching to spinal shortened the anesthesia to incision interval, other studies noted that epidural activation or immediate GA achieved shorter decision to delivery intervals (DDI) than a new spinal. Spinal anesthesia produced more hypotension without an associated neonatal disadvantage. A recent epidural top-up increased the risk of a failed or high spinal. Removing a suboptimal epidural to perform a new neuraxial block improved success compared with attempting to activate the existing catheter. GA was fastest for category 1 deliveries, but was linked to worse neonatal condition and greater maternal blood loss. The evidence suggested extending a well-functioning epidural is a rapid option. For a poorly functioning catheter, a new spinal block is more reliable. Streamlined neuraxial pathways reduce avoidable GA conversions without compromising neonatal outcomes.

Key words: Effectiveness, spinal anesthesia, epidural anesthesia, obstetric surgery, emergency setting, systematic review


 
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How to Cite this Article
Pubmed Style

Alanazi MM, Hassan AM, Zamzamy NA, Alharbi FA, Alsulami SH, Zamzamy HA, Aljaber KM, Alzhrany MA, Alosaimi AN, Alzhrany FA. Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting. IJMDC. 2025; 9(10): 2545-2551. doi:10.24911/IJMDC.51-1760553301

Web Style

Alanazi MM, Hassan AM, Zamzamy NA, Alharbi FA, Alsulami SH, Zamzamy HA, Aljaber KM, Alzhrany MA, Alosaimi AN, Alzhrany FA. Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting. https://www.ijmdc.com/?mno=290549 [Access: December 09, 2025]. doi:10.24911/IJMDC.51-1760553301

AMA (American Medical Association) Style

Alanazi MM, Hassan AM, Zamzamy NA, Alharbi FA, Alsulami SH, Zamzamy HA, Aljaber KM, Alzhrany MA, Alosaimi AN, Alzhrany FA. Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting. IJMDC. 2025; 9(10): 2545-2551. doi:10.24911/IJMDC.51-1760553301


Vancouver/ICMJE Style

Alanazi MM, Hassan AM, Zamzamy NA, Alharbi FA, Alsulami SH, Zamzamy HA, Aljaber KM, Alzhrany MA, Alosaimi AN, Alzhrany FA. Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting. IJMDC. (2025), [cited December 09, 2025]; 9(10): 2545-2551. doi:10.24911/IJMDC.51-1760553301


Harvard Style

Alanazi, M. M., Hassan, . A. M., Zamzamy, . N. A., Alharbi, . F. A., Alsulami, . S. H., Zamzamy, . H. A., Aljaber, . K. M., Alzhrany, . M. A., Alosaimi, . A. N. & Alzhrany, . F. A. (2025) Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting. IJMDC, 9 (10), 2545-2551. doi:10.24911/IJMDC.51-1760553301


Turabian Style

Alanazi, Mazi Mohammed, Ahmed Mohamed Hassan, Nedaa Ahmed Zamzamy, Fatimah Abdullah Alharbi, Shahad Hamdan Alsulami, Hifaa Ahmed Zamzamy, Khalid Mohammed Aljaber, Mohammed Abdulhavidh Alzhrany, Ashwaq Naif Alosaimi, and Faris Abdulhavidh Alzhrany. 2025. Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting. International Journal of Medicine in Developing Countries, 9 (10), 2545-2551. doi:10.24911/IJMDC.51-1760553301


Chicago Style

Alanazi, Mazi Mohammed, Ahmed Mohamed Hassan, Nedaa Ahmed Zamzamy, Fatimah Abdullah Alharbi, Shahad Hamdan Alsulami, Hifaa Ahmed Zamzamy, Khalid Mohammed Aljaber, Mohammed Abdulhavidh Alzhrany, Ashwaq Naif Alosaimi, and Faris Abdulhavidh Alzhrany. "Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting." International Journal of Medicine in Developing Countries 9 (2025), 2545-2551. doi:10.24911/IJMDC.51-1760553301


MLA (The Modern Language Association) Style

Alanazi, Mazi Mohammed, Ahmed Mohamed Hassan, Nedaa Ahmed Zamzamy, Fatimah Abdullah Alharbi, Shahad Hamdan Alsulami, Hifaa Ahmed Zamzamy, Khalid Mohammed Aljaber, Mohammed Abdulhavidh Alzhrany, Ashwaq Naif Alosaimi, and Faris Abdulhavidh Alzhrany. "Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting." International Journal of Medicine in Developing Countries 9.10 (2025), 2545-2551. Print. doi:10.24911/IJMDC.51-1760553301


APA (American Psychological Association) Style

Alanazi, M. M., Hassan, . A. M., Zamzamy, . N. A., Alharbi, . F. A., Alsulami, . S. H., Zamzamy, . H. A., Aljaber, . K. M., Alzhrany, . M. A., Alosaimi, . A. N. & Alzhrany, . F. A. (2025) Comparative effectiveness of spinal versus epidural anesthesia in urgent emergency obstetric surgery in an emergency setting. International Journal of Medicine in Developing Countries, 9 (10), 2545-2551. doi:10.24911/IJMDC.51-1760553301




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