Spinal Anaesthesia For Caesarean Section Research Articles

Comparison of general anesthesia and spinal anesthesia for cesarean section: effects and postpartum nursing care.

Comparison of general anesthesia and spinal anesthesia for cesarean section: effects and postpartum nursing care.

Letter to the editor for the article "Comparative dose-response study on the infusion of norepinephrine combined with intravenous ondansetron versus placebo for preventing hypotension during spinal anesthesia for cesarean section: a randomised controlled trial".

Letter to the editor for the article "Comparative dose-response study on the infusion of norepinephrine combined with intravenous ondansetron versus placebo for preventing hypotension during spinal anesthesia for cesarean section: a randomised controlled trial".

Co-Loading Versus Pre-Loading for Preventing Post-Spinal Hypotension in Caesarean Section

Co-Loading Versus Pre-Loading for Preventing Post-Spinal Hypotension in Caesarean Section

The Median Effective Dose of Intrathecal Hyperbaric Bupivacaine for Cesarean Section at Moderately High-Altitude.

Alterations in altitude can lead to an augmented requirement for local anesthesia among patients. Nevertheless, the necessity for an elevated dosage of local anesthetic for parturients at moderately high altitudes during spinal anesthesia for cesarean section remains uninvestigated. This up-down sequential study endeavors to determine the ED50 dose of bupivacaine required for spinal anesthesia during cesarean sections at moderately high-altitude. Thirty singleton parturients at moderately high altitude underwent elective cesarean section under combined spinal-epidural anesthesia. The up-and-down sequential method was employed, starting with an initial dose of 12mg (1.6mL) of 0.75% hyperbaric bupivacaine for the first participant. The dose for the next case was adjusted up or down by 0.75mg based on the effectiveness of the previous participant. Effectiveness was defined as the bilateral sensory block reaching T6 within 15 minutes after spinal anesthesia injection, without the need for additional epidural anesthesia before fetal delivery. The ED50 dose and 95% confidence interval were calculated using the Dixon sequential method and isotonic regression, respectively. The incidence of maternal hypotension, nausea, and vomiting during the study period was also recorded. The ED50 of hyperbaric bupivacaine for spinal anesthesia in cesarean section was calculated as 8.23 mg (95% CI, 6.52-9.32 mg) using the Dixon up-and-down method. Further validation using isotonic regression yielded a value of 8.39 mg (95% CI, 7.48-9.30 mg), confirming the accuracy and sensitivity of the conclusion. During the operation, only 6 parturients experienced hypotension, and no adverse reactions such as nausea, vomiting, and shivering were observed. The ED50 dose of 0.75% hyperbaric bupivacaine for spinal anesthesia during cesarean section at moderately high altitude is 8.23 mg, which exceeds the ED50 dose typically required by parturients at low altitude. Comprehensive investigations are warranted to ascertain the ED90 or ED95 dose of local anesthetics for cesarean section at moderately high altitudes, thereby offering enhanced guidance for clinical practice.

Effect of Patient Position during Spinal Anesthesia on the Incidence of Post-Dural Puncture Headache after Cesarean Section

Objective: To compare the incidence of post-dural puncture headache (PDPH) following spinal anesthesia in parturients undergoing elective cesarean section between the sitting and left lateral decubitus positions. Methodology: This quasi-experimental study was conducted at Holy Family Hospital, Rawalpindi, Pakistan, from May 2022 to October 2022. A total of 120 parturients undergoing elective cesarean section under spinal anesthesia were randomly assigned to either the sitting or left lateral decubitus position group. The primary outcome was the occurrence of PDPH within 5 days postoperatively. Secondary outcomes included adverse effects such as hypotension, nausea/vomiting, and bradycardia. Data were analyzed using SPSS version 25.0. Categorical variables were compared using the chi-square test or Fisher's exact test, as appropriate, with a significance level set at p < 0.05. Results: The incidence of PDPH post-procedure was significantly higher in the sitting group compared to the left lateral decubitus group (33.3% vs. 6.7%). In the sitting position group, 63.3% of women experienced hypotension, 26.7% had bradycardia, and 30.0% reported nausea/vomiting, whereas in the left lateral decubitus group, these figures were 58.3%, 21.7%, and 23.3%, respectively. Conclusion: This study concludes that the left lateral decubitus position during spinal anesthesia for cesarean section is associated with a lower incidence of PDPH compared to the sitting position.

Generalized Tonic-Clonic Seizure`s Following Spinal Anesthesia for Cesarean Section Using Bupivacine Heavy with Case Reports

Generalized Tonic-Clonic Seizure`s Following Spinal Anesthesia for Cesarean Section Using Bupivacine Heavy with Case Reports

Letter to the editor: "Comparative dose-response study on the infusion of norepinephrine combined with intravenous ondansetron versus placebo for preventing hypotension during spinal anesthesia for cesarean section: a randomised controlled trial".

Letter to the editor: "Comparative dose-response study on the infusion of norepinephrine combined with intravenous ondansetron versus placebo for preventing hypotension during spinal anesthesia for cesarean section: a randomised controlled trial".

Comparative dose-response study on the infusion of norepinephrine combined with intravenous ondansetron versus placebo for preventing hypotension during spinal anesthesia for cesarean section: a randomised controlled trial.

Ondansetron has been reported to attenuate the incidence of spinal anaesthesia-induced hypotension (SAIH) and norepinephrine requirement during caesarean section. However, no quantitative study has evaluated the extent of this effect. This study aimed to determine the dose-response of prophylactic infusion of norepinephrine to prevent SAIH in parturients who received intravenous ondansetron or placebo before spinal anaesthesia for caesarean section. The median effective dose (ED 50 ) and 90% effective dose (ED 90 ) were compared to evaluate the effect of ondansetron versus placebo on the norepinephrine requirement. One hundred fifty parturients undergoing caesarean section were randomized to receive either 0.1mg/kg ondansetron (group O) or saline control (group C) 10 min before spinal anaesthesia. The parturients were randomly assigned to one of five different norepinephrine infusion groups: 0.02, 0.04, 0.06, 0.08 or 0.10µg/kg/min. An effective infusion dose of norepinephrine was defined as non-occurrence of hypotension during the study period. The values for ED 50 and ED 90 of norepinephrine infusion were determined using probit regression. Differences between the two groups were evaluated by comparing the relative median potency with 95% CIs. The ED 50 values were 0.033 (95% CIs, 0.024-0.043) µg/kg/min in group C and 0.021 (95% CIs, 0.013-0.029) µg/kg/min in group O. The ED 90 values were 0.091 (95% CIs 0.068-0.147) µg/kg/min in group C and 0.059 (95% CIs 0.044-0.089) µg/kg/min in group O, respectively. The estimate of the relative median potency for norepinephrine in group C versus group O was 0.643 (95% CIs, 0.363-0.956). The incidence of side effects was comparable between groups. No significant difference in neonatal outcomes. Intravenous ondansetron 0.1mg/kg before spinal anaesthesia significantly reduced the dose requirement of prophylactic norepinephrine infusion in parturients undergoing elective caesarean section. This finding is potentially useful for clinical practice and further research.

Risk factors of more severe hypotension after spinal anesthesia for cesarean section.

The aim of this study was to examine the risk factors associated with the use of vasopressors to prevent hypotension that occurs after spinal anesthesia during cesarean section. Although the prophylactic use of vasopressors is already suggested as routine care in many parts of the world, the occurrence of spinal anesthesia-induced hypotension (SAIH) is still common in parturients. This retrospective study included parturients receiving elective cesarean deliveries under spinal anesthesia from April 2016 to March 2020. Risk factors related to ephedrine dosage were analyzed using a hurdle model, and risk factors related to SAIH were further analyzed with logistic regression. Five risk factors, namely maternal body mass index (BMI, p < 0.001), baseline systolic blood pressure (SBP, p < 0.001), baseline heart rate (HR, p = 0.047), multiparity ( p = 0.003), and large fetal weight ( p = 0.005) were significantly associated with the requirement for ephedrine. Furthermore, a higher ephedrine dosage was significantly associated with maternal BMI ( p < 0.001), baseline SBP ( p < 0.001), baseline HR ( p < 0.001), multiparity ( p = 0.027), large fetal weight ( p = 0.030), maternal age ( p = 0.009), and twin pregnancies ( p < 0.001). Logistic regression analysis also showed that the same five risk factors-maternal BMI ( p = 0.030), baseline SBP ( p < 0.001), baseline HR ( p < 0.001), multiparity ( p < 0.001), and large fetal weight ( p < 0.001)-were significantly associated with SAIH, even in cases where vasopressors were administered. These findings can be useful for clinicians when deciding the dose of prophylactic ephedrine or phenylephrine to prevent SAIH.

Intravenous ondansetron for the prevention of supine hypotensive syndrome during spinal anesthesia for cesarean section: a randomized controlled trial.

Background: Supine hypotensive syndrome is a common complication in late pregnancy. This study aims to explore the effects of ondansetron on the prevention of supine hypotensive syndrome during spinal anesthesia for cesarean section. Methods: A total of 80 women undergoing elective cesarean delivery were randomly assigned to two groups (the ondansetron group and the control group), with 40 cases in each group. The ondansetron group received 0.075mg/kg of ondansetron intravenously 5min before the induction of spinal anesthesia; the control group was given the same volume of saline solution. The blood pressure and heart rate were measured. Umbilical artery pH was analyzed, and the incidence of nausea and vomiting and vasoconstrictor drug usage were noted. Results: The incidence of supine hypotensive syndrome, nausea and vomiting, and vasoconstrictor drug use were significantly lower in the ondansetron group than the control group (2.5% vs. 20%, p = 0.029; 2.5% vs. 22.5%, p = 0.007; and 5% vs. 22.5%, p = 0.012, respectively). Umbilical artery pH was higher in the ondansetron group than the control group, and statistical significance was observed (7.31 ± 0.03 vs. 7.28 ± 0.04, p = 0.002). The maternal hemodynamic parameters and the neonatal Apgar score were similar between the two groups. Conclusion: Ondansetron can effectively prevent supine hypotensive syndrome, reduce the incidence of nausea, vomiting, and vasoconstrictor drug use, and improve neonatal umbilical arterial pH during spinal anesthesia for cesarean section. Clinical Trial Registration: https://www.chictr.org.cn/, identifier ChiCTR180018756.

The effect of adding dexmedetomidine or dexamethasone to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section.

Many strategies are available to prevent spinal-induced hypotension in cesarean section, especially the use of a low dose of spinal anesthesia combined with adjuvants. This study investigated the effect of adding either dexmedetomidine or dexamethasone to the intrathecal bupivacaine-fentanyl mixture on the postoperative analgesia duration, after elective cesarean section. This prospective, randomized, double-blind study was conducted on 90 full-term parturients undergoing elective cesarean section, who were randomly distributed into three groups. They all received spinal anesthesia with the bupivacaine-fentanyl mixture (2.5 ml), in addition to 0.5 ml normal saline (control group), 5 μg dexmedetomidine dissolved in 0.5 ml normal saline (dexmedetomidine group), or 2 mg dexamethasone (dexamethasone group). The time to the first request of morphine rescue analgesia was recorded, in addition to the total dose of morphine consumed in the first 24 h after surgery, the postoperative numerical rating score (NRS), and maternal and fetal outcomes. As compared to the control group and the dexamethasone group, the use of dexmedetomidine as an additive to the bupivacaine-fentanyl mixture significantly prolonged the time to the first request of rescue analgesia, decreased postoperative morphine consumption, and decreased the pain score 4 and 6 h after surgery. There was an insignificant difference between the control and dexamethasone groups. The use of dexmedetomidine as an additive to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section prolonged the postoperative analgesia and decreased the postoperative opioid consumption in comparison to the addition of dexamethasone or normal saline.

Prophylactic, Manually Titrable Variable Rate Norepinephrine Infusion for Prevention of Hypotension during Spinal Anesthesia for Cesarean Section: A Randomized, Double Blind, Controlled Study

Background and Aims: Norepinephrine is recently being investigated for mitigation of spinal-induced hypotension. Our study aimed at evaluating the role of manually titrated infusion of norepinephrine in preventing hypotension in patients undergoing lower segment cesarean section (LSCS) under subarachnoid block (SAB). Subjects and Methods: This prospective, randomized, double-blind, placebo-controlled trial was conducted in 140 parturients undergoing LSCS under SAB. Patients were randomly allocated to two groups: group A received an infusion of 5 µg/mL norepinephrine started at 30 mL/h (2.5 µg/min) immediately after SAB and manually adjusted within the range 0–60 mL/h (0–5 µg/min), according to the values of systolic blood pressure (SBP) until delivery; in group B, no prophylactic vasopressor was given, and bolus 1 mL norepinephrine (5 µg) was given whenever the SBP decreased to &lt;80% of the baseline value. Groups were compared with regard to the incidence of hypotension, hemodynamic parameters, and norepinephrine consumption. Categorical data were presented as number and compared using the Chi-square test. Continuous variables were presented as mean ± standard deviation (SD) and compared using t-test. P &lt;0.05 was considered statistically significant. Results: Cumulative episodes of hypotension were significantly lesser in group A (eight) than group B (29) (P &lt; 0.001). Mean time of onset of hypotension was significantly higher in group A (19.75 ± 8.24 min) compared to group B (4.36 ± 0.77 min) (P &lt; 0.001). Mean SBP, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were significantly higher in group A compared to group B intraoperatively (P &lt; 0.001). Mean heart rate (HR) was significantly lower in group A compared to group B (P &lt; 0.05). Neonatal outcomes were comparable between both the groups. Conclusions: In patients undergoing SAB for LSCS, a manually titrated infusion of 5 µg/mL of norepinephrine was effective for maintaining BP and decreasing the incidence of hypotension, with no detectable detrimental effect on neonatal outcome.

Norepinephrine versus phenylephrine for managing maternal hypotension during cesarean delivery under spinal anesthesia: a meta-analysis of maternal and neonatal outcomes

Norepinephrine or phenylephrine administration to prevent and treat hypotension during spinal anesthesia for cesarean section has been a significant topic of discussion. This meta-analysis aimed to update existing evidence and provide further insights into neonatal and maternal outcomes associated with norepinephrine and phenylephrine. Review of randomized controlled trials (RCTs) was performed to assess the effectiveness of norepinephrine and phenylephrine in managing maternal hypotension during cesarean delivery under spinal anesthesia. Neonatal umbilical cord blood pH and maternal hypotension were the primary outcomes. Based on the analysis of 26 RCTs with 2984 participants, we found no significant difference between the norepinephrine and phenylephrine groups in umbilical artery pH in neonates (mean difference (MD) 0.00; 95% confidence interval (CI) −0.00 to 0.01, p = 0.20). Neonates Apgar scores did not differ between both groups. Norepinephrine was associated with lower incidences of bradycardia (risk ratio (RR) 0.44; 95% CI 0.37 to 0.51, p &lt; 0.001) and reactive hypertension (RR 0.53; 95% CI 0.39 to 0.72, p &lt; 0.001) in parturient women than phenylephrine. In neither group did umbilical cord blood levels of partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and base excess (BE) levels of neonates differ significantly, nor did maternal hypotension, nausea or vomiting incidence during delivery. For maternal hypotension after spinal anesthesia, norepinephrine and phenylephrine did not significantly differ in neonatal acidemia. Despite similarities to phenylephrine in managing hypotension and maintaining maternal hemodynamic stability, norepinephrine is a promising alternative.

Crystalloid Preloading versus Prophylactic Ephedrine Infusion for Prevention of Hypotension during Caesarean Section

Context: Central neuraxial blockade is widely practiced in obstetric anesthesia. The prevention of maternal systemic hypotension is of importance. Aim: To compare between crystalloid preloading and prophylactic intravenous ephedrine in the prevention of maternal systemic hypotension after spinal anesthesia for cesarean section. Settings and Design: Study was conducted in a tertiary care hospital; comparative observational study. Methods and Materials: One hundred fifty six healthy parturients, posted for elective cesarean section. The parturients who were preloaded with 10 mL/kg of Ringer Lactate over 20 minutes before spinal anesthesia by treating anesthesiologist were included in Group P. Parturients were administered prophylactic ephedrine 0.125 mg/kg infusion after spinal anesthesia at the onset of sympathetic block by treating anesthesiologist were included in Group E. Statistical Analysis Used: Data were entered in Microsoft excel and analyzed using SPSS software version 25 (IBM). Results: In our study, we found that fall in blood pressure was statistically significant from fourth to 14th minute in Group P compared to Group E. The mean arterial pressure became significantly low in Group P compared to Group E. Heart rate was found to increase in Group P from second minute compared to sixth minute in Group E. Fetal wellbeing assessed by appearance (colour), pulse, grimace (response to touch), activity (tone) and respiration (APGAR) score was better in Group E compared to Group P and was statistically significant. Nausea and vomiting were more in Group P compared to Group E and was statistically significant. Conclusions: We conclude that prophylactic ephedrine infusion has better control over maternal hemodynamic than crystalloid preloading in cesarean section under spinal anesthesia.

Effect of ondansetron in maternal hypotension during cesarean delivery: an observational study

Background: Spinal anesthesia is the most common anesthetic technique for cesarean delivery. Thus, hypotension is associated with a reduction in uteroplacental flow which may induce fetal morbidity. Activation of the Bezold Jarisch reflex (mediated by 5HT3 receptors) can worsen hypotension and decrease cardiac output. We studied the effect of ondansetron administration before spinal anesthesia on the trajectory of blood pressure during cesarean delivery. Methods: We conducted a retrospective chart review of all cesarean deliveries that occurred between April 1st 2020 and April 1st 2021 and included 85 pregnant women (43 with ondansetron and 42 in the control group). Data were obtained from the electronic medical record database of the British Hospital of Buenos Aires. Socio- demographic, obstetric, anesthetic and perioperative characteristics of patients were assessed. Results: There were no significant differences in the trajectories of the change from baseline of mean arterial blood pressure between ondansetron and control group (0.14% (95% CI: 0.06 to 0.21) per minute). This also applied to heart rate (-0.10% per minute (95% CI: -0.19 to 0.01). The need of any infusion (phenylephrine or atropine) comparing ondansetron to the reference group was 1.12 (95% CI: 0.68, 1.85). There were eight events of shivering (16.3%) in the ondansetron exposed group and four events of shivering (8.5%) in the reference group. APGAR values showed no clinical difference between groups. Conclusions: In this single-center cohort study, we did not observe an effect of routine administration of ondansetron before spinal anesthesia in cesarean section on improving arterial blood pressure or heart rate throughout the procedure.

Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study

BackgroundSystemic infection has always been considered a relative contraindication to neuraxial anesthesia, despite the fact that infectious complications are relatively uncommon. Pregnancy-related physiological changes and coronavirus disease (COVID-19) neurotropic features may facilitate the virus’ entry into the central nervous system. The principal aim of this study was to test the safety of spinal anesthesia in “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2)-positive pregnant women and to examine cerebrospinal fluid (CSF) characteristics.MethodsWe conducted a prospective observational single-center study in asymptomatic or paucisymptomatic consecutive pregnant SARS-CoV-2 patients who underwent spinal anesthesia for cesarean section. Women with severe infection were excluded because they underwent general anesthesia. At the time of spinal anesthesia, we collected CSF samples, and then we performed a chemical-physical analysis to look for signs of inflammation and for SARS-CoV-2 genome.ResultsWe included 26 women. No spinal anesthesia complications were reported in the perioperative period and after 2 months. All CSF samples were crystal clear, and all physical-chemical values were within physiological ranges: the median concentration of CSF/plasma glucose ratio was 0.66, IQR 0.5500 (0.6000–0.7100), and the average CSF protein concentration value was 23.2 mg/dl (SD 4.87). In all samples, genomes of SARS-CoV-2 and other neurotropic viruses were not detected.ConclusionsSpinal anesthesia was safe in SARS-CoV-2 pregnant women with mild disease; no clinical maternal complications were detected, and no CSF changes indicative of inflammatory or infectious diseases that would compromise the safety of the procedure were found.

Neostigmine and atropine as a treatment for postdural puncture headache after spinal anesthesia in cesarean section: A case report

Key Clinical messageNeostigmine and atropine offer a promising treatment option for postdural puncture headache (PDPH) following spinal anesthesia in cesarean section, providing effective relief with a favorable risk–benefit profile.AbstractPostdural puncture headache (PDPH) is a common consequence of cesarean section surgeries after spinal anesthesia. This case study describes the successful treatment of PDPH with intravenous neostigmine and atropine. A 31 years female who underwent elective cesarean section with spinal anesthesia developed a severe headache on the 6th postoperative day and was diagnosed to have PDPH. PDPH failed to respond to conventional treatment modalities like hydration, a Non‐steroidal anti‐inflammatory drug, and sphenopalatine ganglion block. Epidural blood patch could not be performed due to lack of consent. A trial dose of intravenous neostigmine (20 mcg/kg) along with atropine (10 mcg/kg) successfully provided symptomatic and clinical relief. The combination of neostigmine and atropine demonstrates a rapid onset of action, providing patients with effective analgesia while avoiding the need for invasive procedures such as epidural blood patches and offers quicker pain relief. This promising result warrants additional research.

Factors Predisposing to Postdural Puncture Headache after Spinal Anaesthesia among Elective Caesarean Section Patients at Thika Level 5 Hospital, Kenya

Background: Postdural puncture headache (PDPH) is a common complication following spinal anaesthesia for Caesarean section (CS). There is little data on the incidence and its predisposing factors in low-income countries. The study aimed to investigate the incidence and factors predisposing patients to PDPH after a dural puncture during a planned Caesarean section under spinal anaesthesia at Thika Level 5 Hospital, Kenya.&#x0D; Methods: A cross-sectional study design was used. Pregnant women scheduled for planned Caesarean sections under spinal anaesthesia at Thika Level 5 Hospital were randomly recruited. Data was collected during the fourth quarter of 2021. Patient factors (age, BMI, bed rest, and previous history of PDPH), healthcare provider factors (qualification, experience, and the number of dural punctures), and equipment factors (size, design, and spinal needle orientation) were evaluated to determine predisposing factors for PDPH. Sample size obtained by the use of Fisher’s formula, resulting in a sample size of 103.&#x0D; Results: We found the incidence of PDPH at Thika Level 5 Hospital to be 24.5%. Patient and equipment factors were found to be associated with PDPH. Among the patient factors, high BMI was found to be significant (p = 0.039) while among the equipment factors, traumatic needle tip design (p = 0.049) and the perpendicular orientation of needle bevel (p = 0.022) were found to be associated with PDPH.&#x0D; Conclusion and Recommendations: We conclude that PDPH is a common complication following spinal anaesthesia for Caesarean section, and the incidence (24.5%) is relatively high at Thika Level 5 Hospital. High BMI, traumatic cutting spinal needle tip design and perpendicular orientation of the needle bevel are predisposing factors. Further research is needed to determine the predisposing factors of PDPH at different levels of hospitals in Kiambu County, and understand the specific mechanisms and measures to minimize the incidence PDPH

Perioperative Analgesia and Patients' Satisfaction in Spinal Anesthesia for Cesarean Section: Fentanyl Versus Morphine.

Perioperative analgesia for cesarean section aims to ensure the mother's comfort, facilitate a smooth surgical experience, and promote a successful recovery. One-hundred-ninety patients were enrolled in a randomized double-blind study designed to assess the quality of perioperative analgesia, level of satisfaction, and incidence of adverse reactions in elective cesarean section under spinal anesthesia when fentanyl or morphine was added to bupivacaine. Two treatment groups comprising 173 subjects were compared in the per-protocol analysis: F (fentanyl, standard dose 25 μg) and M (morphine, standard dose 100 μg). Numerical pain scores were recorded perioperatively for 72 h (both at rest and on mobilization), with overall postoperative satisfaction and analgesic-related side effects. The patients in the morphine group had significantly better pain management (Mann-Whitney U test, p < 0.001) and higher level of satisfaction (Mann-Whitney U test, p < 0.001). The latter was related to the greater need for rescue medication in the fentanyl group (OR = 4.396; p = 0.019). On the other hand, fentanyl had significantly fewer non-life-threatening side effects, such as high-intensity pruritus (Mann-Whitney U test, p < 0.001), nausea (OR = 0.324; p = 0.019), vomiting and dizziness upon first mobilization (OR = 0.256; p < 0.001). It remains for future clinical trials to help establish doses that will tilt the scale to one side or the other.

Anesthesia management of superobese pregnant patient under spinal anesthesia in cesarean section

Morbidly obese parturient requires specialized anesthetic care for safe labour and delivery. Regional anesthesia is considered safer than general anesthesia for cesarean section in super morbid obese parturient. We present this case to discuss anesthetic challenges associated with regional anesthesia and our approach in successful management of cesarean section in super morbid obese parturient.