Background: Spinal anesthesia is the preferred anesthetic technique for cesarean section due to its safety profile, rapid onset, and reduced maternal morbidity compared to general anesthesia. Despite these advantages, refusal of spinal anesthesia remains common among obstetric patients, often influenced by misconceptions, fear, and socio-demographic factors, which may affect anesthetic management and maternal outcomes.
Objectives: To determine the frequency of refusal of spinal anesthesia and to identify the underlying causes among obstetric patients undergoing elective cesarean section.
Study Design & Setting: This cross-sectional study was conducted in the Department of Anesthesia, Dow University of Health Sciences, Karachi, over a period of six months from May to October 2025.
Methodology: A total of 171 obstetric patients aged 18–40 years, scheduled for elective cesarean section and meeting the inclusion criteria, were enrolled using non-probability consecutive sampling. Data regarding demographic characteristics, obstetric variables, and refusal of spinal anesthesia were collected after standardized pre-anesthetic counseling using a structured proforma. Causes of refusal were recorded as self-reported fears, including needle prick pain, post-spinal backache, awareness during operation, and peri-operative pain. Data were analyzed using IBM SPSS version 23, and associations were assessed using the chi-square test, with p ≤ 0.05 considered statistically significant.
Results: Out of 171 patients, 95 (55.56%) refused spinal anesthesia. The most common causes of refusal were fear of needle prick pain (42.1%), peri-operative pain (35.8%), awareness during operation (31.6%), and post-spinal backache (28.4%). Refusal was significantly higher among uneducated patients (80.0%) compared to those with higher education (p = 0.0005). Age showed a significant association with specific causes of refusal, particularly needle prick pain and peri-operative pain (p < 0.05).
Conclusion: Refusal of spinal anesthesia was common among obstetric patients and was primarily driven by fear and lack of awareness. Targeted counseling and patient education may improve acceptance and optimize anesthetic care.
Keywords: Anesthesia, Cesarean Section, Obstetrics, Refusal, Spinal Anesthesia, pomegranate peel, flavonoids, organic acids, ultrasonic extraction, maceration, antioxidant activity
How to cite this article: Arif S, Iqbal S, Motiwala S, Masnoon U, Meraj S, Mehmood H. Frequency and causes of refusal of spinal anesthesia in obstetrics patients. Int J Drug Deliv Technol. 2026;16(3s): 382-387; DOI: 10.25258/ijddt.16.3s.48