Regional anaesthesia for caesarean section and what to do when it fails

Abstract 

Almost 90% of caesarean sections in the UK are carried out under regional anaesthesia. Preoperatively, women should be assessed and given adequate information regarding the regional technique. Antacid premedication and, in elective cases, an appropriate starvation period are mandatory. Regional anaesthesia should be established in the operating theatre, with both maternal and fetal monitoring in progress. Single-shot spinal is currently the most popular technique. Before surgery starts, assessment and documentation of the block are essential. Sensory block to light touch, and/or cold, should be measured. Surgery should be halted, if possible, if there is pain. Analgesic options include Entonox, intravenous opioids or ketamine, epidural ‘top-up’ and local infiltration; however, general anaesthesia should always be offered. All women should be followed up within 24 hours by the anaesthetic team.

Keywords: caesarean, combined spinal epidural, epidural, regional anaesthesia, single-shot