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.
Keywords
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Article Info
Publication History
Published online: July 18, 2022
Royal College of Anaesthetists CPD Skills Framework: ObstetricsPublication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Published by Elsevier Ltd.
