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

Abstract

Regional anaesthetic techniques are the commonest type of anaesthetic for caesarean birth primarily due to their safety profile compared to general anaesthesia in pregnant women. The selection of a regional technique is influenced by both patient and surgical factors. Caution is essential regarding the timing of regional anaesthesia in patients who are receiving anticoagulation or have clotting abnormalities. Information on the risks and benefits of regional anaesthesia should be provided to facilitate informed decision-making. Prior to any operative obstetric intervention a full blood count, group and save should be performed and antacid prophylaxis should be administered. A 15° left lateral tilt must be maintained until delivery along with implementation of strategies to manage hypotension. Confirmation of adequate anaesthesia and appropriate block height is required following the administration of the regional technique before initiating the surgery and plans for addressing potential failures of regional anaesthesia should be established. Breakthrough pain during the caesarean birth is a significant concern that must be recognized and managed. Intravenous fast-acting opioids may be employed, while other analgesic options include nitrous oxide, ketamine, and local anaesthetic infiltration. If effective analgesia is deemed unlikely through these alternative methods, general anaesthesia should be considered. Postoperative follow-up is crucial for identifying any complications related to regional anaesthesia and ensure sufficient postoperative pain management.