Regional anesthesia for cesarean section

Abstract

Spinal or epidural local anesthetics are common and very reliable ways to provide anesthesia for cesarean section. Regional anesthesia avoids many of the maternal risks associated with general anesthesia. Spinal anesthesia is a good choice for elective cesarean section. In laboring women, epidural analgesia can be readily converted to epidural anesthesia. The combined spinal epidural technique is useful when surgery may be prolonged and in patients who may not tolerate standard doses of intrathecal local anesthetic. This article reviews some technical aspects to consider when performing regional anesthesia for cesarean section. It offers suggested protocols for each of these techniques. Lastly, it discusses two common clinical situations: the inadequate epidural anesthetic and the conversion of labor epidural analgesia to operative epidural anesthesia.