Neuraxial block applications in cesarean section in turkeyevaluation of the approach

Objective: In our study, it was aimed to evaluate the practical approaches of Anesthesiology and Reanimation specialists and research assistants working in Turkey to neuraxial block applications in cesarean section surgeries. Material and Method: In the study, anesthesiology and reanimation specialists and research assistants working in the Republic of Turkey between April 1, 2021 and June 1, 2021 were reached online and a 48-question survey about the use of neuraxial block in obstetric anesthesia applications was applied. Results: As a result of our study, a total of 212 Anesthesiology and Reanimation specialists and research assistants were reached. 54.2% (n=115) of the participants were female. The largest group among the participants consisted of experts (53.8%, n=114) and research assistants (28.3%, n=60). While 73.7% (n=156) of the participants thought that neuraxial training was sufficient, the rate of those who thought that the level of practice was sufficient was determined as 76.5% (n=162). Neuraxial block application rates in cesarean section operations were found to be over 99%. It was observed that the most important factor for not performing neuraxial block was the patient's unwillingnes (90.5%; n=191). 70.1% (n=148) of the participants knew that aspirin use should not be discontinued before neuraxial block application. It was found that the most common rule during neuraxial block application was wearing sterile gloves (99.5%; n=210), and the least followed rule was hand washing (53.1%; n=112). The most preferred position during neuraxial block application is sitting (93.4%; n=198). While almost all of the participants (99.5%; n=211) preferred midline intervention, the number of those who preferred the use of ultrasonography during the intervention was 3. While 94.9% (n=201) of the participants preferred hyperbaric bupivacaine in spinal anesthesia applications, the rate of those who preferred fentanyl as an opioid was 93.9% (n=199). The three most feared complications during spinal anesthesia are high spinal block (85.4%; n=181), spinal hematoma (79.3%; n=168) and post-spinal headache (51%; n=108). found. While the most preferred vasopressor in the treatment of hypotension was ephedrine (80.8%; n=171), the rate of those who preferred phenylephrine was 1.5% (n=3). The majority of the participants (76.3%; n=161) reported that they applied autologous epidural blood patch if they did not respond to conservative and pharmacological treatment. The most preferred local anesthetic during epidural anesthesia was bupivacaine (76.3%; n=161); the opioid was fentanyl (87.1%; n=184). The 3 most feared complications after epidural anesthesia are epidural hematoma (86.1%; n=182), total spinal anesthesia (83.5%; n=177) and local anesthesia toxicity (69.1%; n=146). detected. In case of accidental dural puncture during epidural application, the majority of participants follow the patient with follow-up and bolus fluid intake (76.3%; n=161). The rate of those who advanced the epidural catheter into the dural space was determined as 19.1%. Conclusion: Obstetric anesthesia practices in our country are generally parallel to the world. Small differences are observed for some drugs that are frequently used in neuraxial block applications around the world, since accessibility is limited in Turkey.