Ahmed FAKRI, Maha Sekkal, Youssef Halhoul, Mourad Ababou, Marouane Jidal, Mustapha Bensghir
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 5
Date of Publication: 2026/05/28
Introduction Spinal anesthesia is widely used for lower abdominal, pelvic, obstetric, urological, and lower-limb orthopedic procedures. Although it is considered a reliable neuraxial technique, failure may occur and can lead to intraoperative pain, intravenous analgesic supplementation, conversion to general anesthesia, surgical delay, postoperative complications, and patient dissatisfaction. Data regarding failed spinal anesthesia in Morocco remain limited. This study aimed to determine the estimated failure rate, characteristics, and perioperative consequences of failed spinal anesthesia at Mohammed V Military Teaching Hospital, Rabat.
Methods We conducted a single-center prospective observational study over a one-year period from April 2025 to April 2026. Failed spinal anesthesia cases were reported using a standardized electronic Google Forms questionnaire completed by anesthesia providers whenever a failure occurred. The institutional annual surgical activity included 12,100 procedures, of which 4,012 were performed under spinal anesthesia. Failed spinal anesthesia was defined as any spinal block that did not allow surgery to be completed under adequate anesthesia without additional anesthetic intervention. Collected variables included patient characteristics, body mass index, American Society of Anesthesiologists physical status, anatomical risk factors, surgical specialty, urgency, procedure timing, provider experience, spinal anesthesia technique, intervertebral space, needle type and gauge, number of attempts, intrathecal drugs, sensory level, intraoperative pain, analgesic supplementation, conversion to general anesthesia, perioperative complications, postoperative intensive care admission, surgical delay, and satisfaction. Data were analyzed using Jamovi version 2.2.5.
Results A total of 120 (3.0%) failed spinal anesthesia cases were reported among 4,012 spinal anesthesia procedures. Of these, 115 (95.8%) cases had complete analyzable data. Partial failure was observed in 65 (56.5%) cases, total failure in 44 (38.3%), and unclear or inconsistent responses in six (5.2%). Intraoperative pain occurred in 97 (84.3%) cases, intravenous analgesic supplementation was required in 96 (83.5%), and conversion to general anesthesia occurred in 56 (48.7%) failed cases. Orthopedic surgery was the most frequent surgical category among failed cases, 30 (26.1%), followed by cesarean section, 27 (23.5%), and urological surgery, 23 (20.0%). More than one puncture attempt was reported in 87 (75.7%) cases. Surgical delay greater than 10 minutes occurred in 83 (72.2%) cases, and postoperative intensive care admission occurred in 23 (20.0%). Patient dissatisfaction or very high dissatisfaction was reported in 53 (46.1%) cases.
Conclusion In this one-year prospective observational study, failed spinal anesthesia occurred in 120 (3.0%) of 4,012 spinal anesthesia procedures. Partial failure, intraoperative pain, analgesic supplementation, surgical delay, and conversion to general anesthesia were common. These findings highlight the need for standardized documentation, careful technical performance, early recognition of inadequate block, and structured management protocols.
Failed spinal anesthesia; spinal anesthesia failure; regional anesthesia; intraoperative pain; conversion to general anesthesia; Morocco; military teaching hospital; perioperative outcomes; spinal blo
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