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Regional anaesthesia for caesarean birth and what to do if it fails

      Abstract

      Regional anaesthetic techniques are the most frequently used type of anaesthetic for caesarean births. They have a better safety profile than general anaesthesia in the pregnant woman. The choice of whether to use a spinal, epidural or combined spinal–epidural technique will depend on patient and surgical factors. Particular care is required in those receiving therapeutic anticoagulation or with clotting abnormalities. Women should be provided with information regarding the risks and intended benefits of the different techniques to make an informed choice regarding mode of anaesthesia. All women having caesarean births must have vital sign monitoring, antacid prophylaxis and intraoperative venous thromboembolic prophylaxis. A left lateral tilt must be maintained until delivery of the baby to reduce the effects of aortocaval compression. Adequate anaesthesia must be confirmed prior to commencing surgery and strategies for managing failed spinal anaesthesia should be defined in local guidelines. Breakthrough pain during caesarean birth is a distressing complication and must be addressed. General anaesthesia should be offered and, if declined, the woman's pain must be adequately managed with alternative analgesic methods. These include nitrous oxide, opioids and local anaesthetic infiltration.

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