Factors associated with anesthetic satisfaction after cesarean delivery under neuraxial anesthesia

INTRODUCTION: Evaluating patient satisfaction with anesthesia is critical for improving their experiences. We investigated perioperative anesthetic satisfaction and associated predictive factors in patients receiving cesarean delivery under neuraxial anesthesia (spinal anesthesia only or combined spinal-epidural anesthesia). METHODS: This was an institutionally approved retrospective chart review of patients who received cesarean delivery under spinal anesthesia and postoperative evaluation administered by anesthesiologists from January 2009 to December 2013. Multiple pregnancies and patients reporting headache prior to cesarean delivery were excluded. Patients were divided into satisfied and not satisfied groups according to their scores from the 4-point Likert scale. Multivariate analysis was used to identify explanatory factors associated with satisfaction. RESULTS: Of 813 patients enrolled, 425 (52.2%) were classified as satisfied. Combined spinal–epidural anesthesia (CSEA) (odds ratio, 3.3; 95% confidence interval, 1.08–10.1) was positively associated with satisfaction. Paresthesia during needle insertion (odds ratio, 0.56; 95% confidence interval, 0.42–0.76), lightning pain during neuraxial anesthesia (odds ratio 0.62; 95% confidence interval, 0.39–0.98), failed block (odds ratio 0.28; 95% confidence interval, 0.09–0.87), and intraoperative use of antiemetic (odds ratio 0.71; 95% confidence interval, 0.53–0.94) were negatively associated with satisfaction. In the 792 patients receiving spinal anesthesia only, the same factors except for CSEA were associated with satisfaction. CONCLUSIONS: The addition of epidural to spinal anesthesia for cesarean delivery can increase patient satisfaction, whereas paresthesia during needle insertion, lightning pain, failed block, and the use of intraoperative antiemetic were major obstacles to patient satisfaction.