ReviewPatient safety in surgery2025
Incidence and predictors of failed spinal anesthesia: a systematic review and meta-analysis.
Review in Patient safety in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Efficacy of coadministration of calcitonin and hyperbaric bupivacaine in spinal anesthesia for unilateral open inguinal hernia repair in tramadol abuse patients: a randomized controlled trial.BMC anesthesiology · 2026Trial
- Incidence, risk factors and outcomes of intraoperative pain during non-elective caesarean section under spinal anaesthesia: a prospective observational study.Journal of anesthesia · 2026Article
- Beyond incidence: clarifying the evidence-based predictors of failed spinal anesthesia.Patient safety in surgery · 2026Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSpinal anesthesia is a widely used and effective regional technique, yet its failure can occur, potentially leading to patient discomfort and requiring alternative methods. Therefore, this systematic review and meta-analysis aimed to assess the pooled incidence of spinal anesthesia failure and identify associated factors.
methodsThis systematic review was prospectively registered in PROSPERO (CRD420251101582). A comprehensive literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, and Google Scholar for studies published between January 2015 and May 2025. Using a random-effects model, we calculated the pooled incidence of failed spinal anesthesia and the pooled odds ratios (ORs) for potential predictors. Heterogeneity among studies was assessed using the I
resultsTwenty-one studies involving 44,790 participants were analyzed. The pooled incidence of failed spinal anesthesia was found to be 8.36% (95% CI: 6.94-9.78). Significant predictors included bar city and dose of local anesthetics, provider inexperience, bloody cerebrospinal fluid, emergency surgery, history of anesthesia, body mass index, lumbar puncture performed at the L4-L5 interspaces, and absence of free CSF flow.
conclusionThe failure rate of spinal anesthesia is significant. Our findings highlight the importance of standardized techniques, optimization of local anesthetic dosage, and continuous training to reduce failures, particularly in resource-limited settings. Key associated factors considered to reduce failures.
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Registered trials
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