Abstract: Currently lumbar epidural is considered to be the gold standard in anaesthesia practice Elements involved in epidural anaesthesia procedure were generally individual to the patient's anatomy, epidural catheter location and response to the medications.. The total of 160 parturients undergoing epidural anaesthesia for lower segment caesarean section LSCS were enrolled in this mono centric study. Parturients were in the range of age 16 -45 years old with ASA 1, II and II involved in the study. Data categorized on phenomenological, physiological, and emotional experience were measured to determine the contributing factors for epidural failure. Visual analogue pain scores VAPS, Brommage scale and perfusion index PI were used as instrument to assess epidural block. Demographic characteristic did not influenced epidural failure, while physiological factors referring to duration of labour (P < 0.05) & perfusion index PI (P < 0.05) at parameter value of 3.99 ? 0.44 contributed to the epidural failure. Elements of emotional experience such as Visual Analogue Pain Score (P < 0.05), Bromage Scale (P < 0.05), Restlessness and patchy block were significantly contributed to the epidural failure. Epidural failure of 3.8% in this study was lowered compared to previous study up to30.0%. Perhaps new heuristics in new Transition Policy Anaesthesia Analysis TAPA can be developed for bridging the gaps in determination of failure for epidural anaesthesia especially for caesarean section. Future direction Technology advances should be used as way to predict epidural failure such as Transcutaneous Electrical Nerve Stimulation (TENS). Ultrasound imaging of the spine could be proposed to facilitate identification of the epidural space and predict difficult spine score, especially in women with abnormal lumbosacral anatomy (scoliosis) and those who were obese. It should be a good level of success in the ultrasound-determined insertion point and very good agreement between ultrasound depth (UD) and needle depth (ND).
Keywords: Pulse Oximetry/Capnograph, Perfusion Value Index SpO2, Epidural Failure, Lower Segment Caesarean Section LSCS, Epidural Anaesthesia/Lumbar Epidural Anaesthesia