Epidural and spinal (subarachnoid) anaesthesia for Caesarean section |
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| Institution: | 1. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran;2. Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA;3. Kiel Institute for the World Economy, Kiel, Germany;4. Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran;5. Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran;6. Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran;7. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism, Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran;8. Division of Hematology and Oncology, Children''s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;1. Department of Anesthesiology, University of Virginia, Charlottesville, VA 22903, USA;2. Department of Neurosurgery, University of Virginia, Charlottesville, VA 22903, USA |
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| Abstract: | Regional anaesthesia for Caesarean section is increasing in popularity — a trend encouraged by obstetric anaesthetists because of its greater safety and the emotional benefits tomother and baby. Such anaesthesia is easier to provide for elective cases, but even in the case of many emergency or semi-emergency Caesarean sections there may be time to extend an epidural already in use, or to use spinal anaesthesia.The reason for the difficulty in providing effective epidural anaesthesia in some cases has been clarified with the identification of variable bands and septa in the epidural space. Spinal block gives more reliable anaesthesia but carries a higher risk of hypotension so that monitoring to detect, and measures to prevent it must be particularly rigorous.Two new developments which are likely to play a part in improving regional anaesthesia for Caesarean section and post-operative pain relief are continuous spinal and combined spinal-epidural techniques. In the case of the former, particular interest is being focused on very fine microcatheters, but the incidence of post-spinal headache with larger catheters is also being reassessed. The combined technique gives the speed of onset and reliability of the spinal block with the flexibility of analgesia provided by the epidural catheter, as well as the advantage of the Tuohy needle acting as guide for the very fine spinal needles. |
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