Epidural anesthesia for caesarean section is effective and preferred. Which method is better for caesarean section: epidural and spinal anesthesia or general anesthesia, what are the differences

A caesarean section is a surgical intervention in which the newborn is removed using an incision in the abdominal wall and uterus. Thanks to this procedure, thousands of children are born every year, so the question of how this operation is carried out worries many future parents. At the same time, one of the most important points to think about on the eve of childbirth is the type of anesthesia.

So, what is the best anesthesia for caesarean section? From the article you can find out basic information about the most commonly used types of anesthesia for this operation, their main advantages and disadvantages.

How is surgery performed?

Before finding out which anesthesia is better for caesarean section, a few words should be said about the essence of this surgical intervention.

During a caesarean section, the newborn is not born naturally (through the birth canal), but is removed through a small incision that the surgeon makes in the wall of the uterus. In modern maternity hospitals, the incision is made in the lower abdomen, so that the scar after the operation is almost invisible. This method of childbirth is very common and widely used in practice: in some European countries, for example in Germany, up to 40% of babies are born in this way.

There are two types of surgery: planned and emergency. The first is done if there is a risk of developing any complications during natural childbirth that threaten the life and health of the woman in labor and the baby. Indications for this operation include a too narrow pelvis of the mother, the threat of hypoxia, childbirth that began prematurely, multiple pregnancy, etc. Naturally, elective surgery is the preferred option, since there is time to prepare the woman in labor for the upcoming operation.

An emergency operation is performed if any dangerous complications have arisen during natural childbirth. At the same time, emergency surgery in most cases is performed using general anesthesia, one of the main advantages of which is the rapid onset of the anesthetic effect: this is very important, because sometimes minutes count during complicated births.

Naturally, such a surgical operation is unthinkable without the use of anesthesia, otherwise the patient may not survive the pain shock.

What types of anesthesia are used for caesarean section?

There are two main types of anesthesia that can be used in the process of caesarean section: regional and First completely desensitizes only the lower half of the body, while in general, the patient's consciousness is completely turned off and all her muscles relax. In this case, the choice of an adequate and most appropriate method of anesthesia can only be carried out by a doctor, taking into account the characteristics of the course of pregnancy, the state of health of the mother and many other factors.

Types of anesthesia for caesarean section:

general anesthesia;
spinal;
epidural.

The main advantages and disadvantages of each are described below.

When can a choice be made in favor of general anesthesia?

The essence of general anesthesia is that, thanks to a complex of drugs that are injected into the venous bloodstream or with the help of a tube inserted into the respiratory tract, the patient's consciousness is completely turned off, and she ceases to experience pain. It is important to note that during general anesthesia, muscle relaxation is observed, which makes it possible to create comfortable working conditions for the obstetrician-surgeon.

This type of anesthesia for women who are to have a caesarean section is chosen relatively rarely. The need for general anesthesia may arise in the following cases:

the presence of contraindications to other existing methods of anesthesia;
the presence of obesity in a woman in labor;
the fetus is diagnosed with hypoxia;
refusal of a woman from other types of anesthesia;
incorrect position of the fetus in the uterus, prolapse of the umbilical cord and other emergency obstetric situations.

Nowadays, with a caesarean section, it is used if there is a need to perform it for emergency indications, and surgical intervention needs to be started urgently in order to save the lives of the woman in labor and the child. This is due to the fact that general anesthesia has a number of significant disadvantages.

Disadvantages of general anesthesia

What is the best anesthesia for caesarean section? Before answering this question, let's talk about its shortcomings. Doctors try to avoid this type of anesthesia for caesarean section, as anesthesia can cause a lot more complications compared to other methods of pain relief. Among the most frequent it is worth highlighting:

hypoxia of the woman in labor, which is caused by the fact that during anesthesia the volume of the lungs decreases and the body's need for oxygen increases;
there is a high risk of aspiration, that is, ingestion of the contents of the stomach into the respiratory tract: if the anesthesiologist does not diagnose this condition in a timely manner, the consequences can be disastrous;
Many women in labor experience high blood pressure during general anesthesia.

The anesthetic can lead to a violation of the respiratory activity of the newborn, and also have a depressing effect on his nervous system due to the penetration of painkillers through the placenta. The latter is especially dangerous if general anesthesia is used for preterm birth. However, you should not be very afraid: modern drugs make it possible to minimize the risk of developing negative consequences for the child, in addition, the newborn receives special medications that relieve the effects of general anesthesia.

Thus, it is up to you and your doctor to decide which anesthesia is better for a cesarean section, but remember that general anesthesia is far from the best way to anesthetize the operation, and you should resort to it only if there are no other options for one reason or another remains. For example, in the event that a woman in labor has an unstable psyche or suffers from any psychiatric diseases, the operation can only be performed under general anesthesia, because there is a high risk that the woman will not be able to remain calm during the operation and will interfere with the actions of the surgeon.

Much more often in practice, epidural and spinal anesthesia are used, that is, regional methods of anesthesia - these types are much safer, moreover, they allow a woman to be in a state of clear consciousness during childbirth. This is important not only because she has the opportunity to immediately pick up a newborn. During a caesarean section, the obstetrician and anesthesiologist can maintain constant contact with the patient, which makes it easier to identify possible complications.

Epidural anesthesia procedure

Before answering the question of which anesthesia is better for caesarean section, it is worth finding out what it is. This is a procedure in which an anesthetic is injected into the epidural space of the spine in the lumbar region. After anesthesia produced by this method, the woman in labor remains conscious during the operation, but does not experience any pain.

With a cesarean section, it allows a woman to take an active part in the process of childbirth: communicate with medical personnel or a spouse present in the ward, immediately pick up a newborn and attach it to her chest. At the same time, the woman in labor does not feel pain, although some note a slight discomfort during the operation.

True, there is one very important nuance. It is psychologically difficult for many women to decide to stay in the operating room, they are afraid that during a caesarean section they will be conscious and not feel half of their body. Often, women in labor insist on general anesthesia. It is advisable to discuss your fears with your doctor and anesthesiologist, who will tell you in detail about how the anesthesia procedure will proceed.

Advantages of epidural anesthesia

Among the main advantages of epidural anesthesia are the following:

Stable functioning of the cardiovascular system, no pressure surges.
Maintaining the ability to move.
Injury to the upper respiratory tract is excluded and there is no risk of aspiration.
Long duration of anesthetic effect. If necessary, anesthesia can be extended for any period, which is very important if, after a cesarean section, it is necessary to perform any other operations, for example, to perform
The woman quickly comes out of anesthesia, the period of postoperative recovery is shortened: just 24 hours after the operation, many patients can get up and move around on their own.
The child can be picked up and put on the breast immediately after the operation.
It is possible to reduce pain after childbirth by injecting painkillers into the epidural space.

Disadvantages of epidural anesthesia

Despite all its advantages, the consequences of epidural anesthesia for caesarean section can be disappointing. Every expectant mother should know about this:

If the anesthetic is administered by an insufficiently experienced specialist, there is a high risk of the drug entering the bloodstream. At the same time, convulsions develop, blood pressure drops sharply and consciousness is depressed. The result can be the death of a woman in labor or irreversible damage to the nervous system.
In about 17% of cases, anesthesia does not block some of the nerves, which is why the woman in labor experiences discomfort during a cesarean section. Therefore, before starting the operation, it is necessary to check the sensitivity using special neurological tests, such as pin pricks. If the anesthetic does not work properly, a re-infusion of the drug is required.
If the medication, due to improper insertion of the catheter, got under the arachnoid membrane of the spinal cord, a spinal block may occur, which often results in respiratory system failure. To avoid this, a small dose of the drug is administered first: it only takes a two-minute wait for the surgical team to determine if the procedure has been performed correctly.

Unfortunately, epidural anesthesia for caesarean section is quite complicated, and its success often depends on the experience and skills of the specialist. Tactile detection of the epidural space is rather indistinct, while a reliable marker is the exit to the surface of the cerebrospinal fluid. Therefore, it is important to choose a doctor who inspires confidence in you, and carefully study the reviews about the work of the maternity hospital in which your baby will be born.

spinal anesthesia

At first, it seemed like a real salvation, because it allowed not only to make the process of the birth of a child completely painless, but also gave women the opportunity not to lose clarity of thinking and perception at the time of the birth of the long-awaited baby. However, due to the numerous contraindications and the likelihood of a number of negative consequences listed above, epidural anesthesia is gradually giving the palm to spinal anesthesia. Many argue that this is the best anesthesia for caesarean section.

Spinal anesthesia is the introduction of an anesthetic into the lumbar region of the back. The drug enters the subarachnoid space of the spinal cord. At the same time, the effect of both types of anesthesia is similar: some time after the injection, the woman in labor ceases to feel the lower half of her body, and the doctor can begin the necessary surgical procedures.

Benefits of Spinal Anesthesia

What is the best anesthesia for caesarean section? It is quite difficult to answer this question, since everyone is individual. But we can highlight the main advantages of spinal anesthesia:

No toxic effect. If an anesthetic accidentally enters the bloodstream, reactions from the heart or nervous system are practically not observed, and there is no risk to the child.
After the operation, the body recovers quite quickly.
High-quality anesthesia: during the operation, the woman in labor does not experience pain.
Spinal anesthesia additionally relaxes the muscles, which facilitates the work of the doctor.
The operation can be started a few minutes after the administration of the drug, so the intervention takes less time.
Spinal anesthesia is much easier to perform than epidural anesthesia. In addition, the anesthesiologist uses a much thinner needle to administer the drug, thereby minimizing the risk of spinal cord injury or erroneous administration of the anesthetic.
Many doctors recognize spinal anesthesia as the most advanced option for caesarean section pain relief.

with caesarean section: contraindications and main disadvantages

Unfortunately, spinal anesthesia also has some disadvantages:

The drug is effective for two hours, so this type of anesthesia is not suitable if you need to perform any additional manipulations, and if complications arise during the operation, additional anesthesia may be required.
Spinal anesthesia is not possible if the patient has certain types of spinal injuries.
Due to the rapid onset of anesthesia, blood pressure may decrease.
If the instruments with which the drugs were administered were not thoroughly disinfected, various infectious complications may occur, for example, meningitis.
After surgery, many women in labor experience severe headaches that can last for several days or even weeks.
As a result of improper insertion of the catheter, the nerve center called the "ponytail" can be damaged. This can cause the innervation of the sacrum and lumbar region to be impaired.
Spinal anesthesia is not possible with some forms of spinal deformity.
Spinal anesthesia is not possible with placental abruption and some other obstetric conditions.

Despite the above disadvantages, spinal anesthesia is considered one of the best and safest techniques for pain relief during caesarean section.

Pain relief for caesarean section: reviews

What is the best anesthesia for caesarean section? Feedback on how women feel during this or that type of anesthesia will help us find the answer to this question.

Young mothers note that the process of getting out of general anesthesia is rather unpleasant: there is a feeling of clouding of consciousness, nausea, headaches and muscle pain. In addition, there is no opportunity to pick up a child immediately after birth. There is another negative consequence of general anesthesia: often after it, the child has respiratory depression.

What is the best anesthesia for caesarean section? Reviews about epidural anesthesia are mostly positive. Women in labor note that after the procedure there are no discomfort, and the child can be immediately applied to the breast. True, as testimonials testify, discomfort is often noted in the area of \u200b\u200badministration of the drug, and in the first few hours after a cesarean section, when the anesthetic is excreted from the body, the lower half of the body trembles violently. However, just a day after the operation, it is possible to stand up, move independently and take care of the newborn.

Spinal anesthesia with mostly deserved positive. Patients note that they did not experience pain during the operation. However, in some cases, for several weeks, women suffer from headaches and discomfort in the abdomen.

How to choose anesthesia?

So what is the best anesthesia for a caesarean section? This article aims to familiarize expectant mothers with what types of anesthesia are used to anesthetize a caesarean section. But remember, in no case should you be guided by the above information when choosing anesthesia! Only a doctor who has all the information about the health of the woman in labor can choose the right type of anesthesia. Of course, the wishes of the patient cannot be ignored. Therefore, before deciding under which anesthesia it is better to do a caesarean section, you should weigh all the pros and cons of this or that method, and consult with the surgeon and anesthesiologist.

In order for the chosen anesthesia to be successful, it is necessary to follow all the recommendations of specialists who will advise how to eat on the eve of the operation, when to get up after a cesarean section and what to do so that the body recovers as quickly as possible.

A caesarean section is a surgical delivery in which the baby is removed through an incision in the mother's abdominal wall and uterus. Today, this operation is quite safe and is actively used in obstetrics. You can read more about the operation in the article, and now we'll talk about how caesarean section is anesthetized.

Today, as anesthesia for caesarean section, the following are used:

General anesthesia.
spinal anesthesia.
epidural anesthesia.

Spinal and epidural anesthesia is also called regional anesthesia.

General anesthesia

General endotracheal anesthesia for planned caesarean section is being performed less and less today. However, this is exactly what is done when the operation needs to be performed on an emergency basis, and there is no time to wait for the anesthesiologist to perform regional anesthesia.

Manipulation takes place in several stages. First, a drug is injected into a woman’s vein, plunging her into a medical sleep and turning off her consciousness. Then a tube is inserted into the trachea to supply a mixture of oxygen with anesthetic gas and artificial ventilation of the lungs. The effect of anesthesia, with the correct administration of drugs, appears almost instantly. The woman is completely unconscious.

Benefits of general anesthesia for caesarean section

instant action in case of urgent operation;
low risk of a drop in blood pressure, stable operation of the cardiovascular system;
complete relaxation of the muscles of the body of the woman in labor, which is very convenient for the surgeon;
the possibility of timely prolongation of action by additional injections, control of the depth of anesthesia;
the opportunity for the mother not to see the operation if she is frightened by such a prospect (despite the fact that even with regional anesthesia, she still will not see the operation, since a screen will be installed at chest level).

Cons and complications after general anesthesia

General anesthesia drugs can affect the child. This is expressed in some oppression muscle activity, nervous and respiratory systems of the baby. As a rule, this action is short-lived and is expressed in the fact that the child after extraction is inactive and does not scream in the first seconds.

But there are also cases of subsequent development of complications, up to hypoxic-ischemic encephalopathy; it all depends on what dose of drugs was administered to the woman and how quickly the baby was removed. However, medicine does not stand still, and every year new drugs appear that minimize the negative impact on the child.

Possibility severe "withdrawal" from anesthesia. It all depends on the individual characteristics of the woman's body: someone suffers from headaches, nausea and confusion even a day after the operation, and someone feels great after a few hours.

Irritation and sore throat, cough - all these are the consequences of not too accurate actions to install the tracheal tube, in addition, coughing after a cesarean section gives a woman a lot of discomfort, so any tension in the abdomen responds with pain.

Aspiration risk- ingestion of the contents of the stomach into the respiratory system due to the fact that when the tube is inserted into the trachea, vomiting may begin.

Probability drug exposure on the cardiovascular system, as well as the occurrence of allergic reactions.

Indications

General anesthesia is performed:

with an urgent caesarean section, when there is a threat to the life of the child or mother;
with the likelihood of complications leading to the removal of the uterus, as well as obstetric bleeding, for example, in the case of placenta previa;
in cases where regional anesthesia is not possible for one reason or another, for example, the mother has a high degree of obesity or spinal injury, low blood pressure, bleeding, and so on.

So, general anesthesia is still quite popular today due to the fact that there is not always an anesthesiologist in the hospital who is able to perform regional anesthesia or there are drugs necessary for this. In addition, new drugs are being developed that make general pain relief increasingly safe for the baby and easily tolerated by the mother.

Regional anesthesia

Anesthesia aimed at local anesthesia is called regional. These include spinal and epidural. The mechanism of these manipulations is very similar: a puncture is made in the lumbar region of the spine, and anesthetics are delivered through it. As a result of both spinal and epidural anesthesia during caesarean section, anesthesia occurs in the lower part of the woman's body, despite the fact that she is conscious.

The main difference between the types of regional anesthesia for caesarean section is the depth of the puncture and the dose of anesthetics. Let's consider in more detail.

spinal anesthesia

Spinal or, as it is also called, spinal anesthesia for caesarean section can be performed both on a planned basis and on an urgent basis, provided that the doctors have about 10 minutes to spare.

The manipulation mechanism is as follows:

A woman needs to sit on the couch with her hands on her knees and arching her back, or lie on her side and pull her legs up to her stomach in order to provide the maximum possible access to the spine;
The woman in labor will be treated with a disinfectant solution around the area around the upcoming puncture;
The anesthesiologist makes an injection of an anesthetic so that the skin and subcutaneous fat lose sensitivity;
A long, thin needle is used to puncture (puncture), an anesthetic is injected into the cerebrospinal fluid (between the vertebrae below the level of the spinal cord);
The needle is removed from the puncture, a sterile napkin is applied and fixed with adhesive tape.

Pain relief occurs almost instantly. The woman does not feel any pain or tactile sensations.

pros

the risk of exposure to drugs on the child is completely excluded;
quick action within a few minutes is a significant indicator, since along with anesthesia, the woman’s pressure level in the lower half of the body drops, which leads to hypoxia of the baby, therefore, the sooner he is brought into the world after the onset of anesthesia, the better;
absolute anesthesia, the risk of partial or insufficient anesthesia is extremely small, in addition, spinal anesthesia for caesarean section provides sufficient muscle relaxation, which facilitates the work of the surgeon;
a small, compared with epidural anesthesia, dose of anesthetics. Due to this, in case of accidental ingestion of drugs into the bloodstream, the risk of toxic poisoning is reduced;
due to the fact that the woman is conscious, there are usually no problems with breathing. If necessary, it is possible to use an oxygen mask;
a woman in labor hears the first cry of her baby and can immediately attach it to her breast;
for an anesthesiologist, the manipulation of spinal anesthesia for cesarean requires less effort and skill than, for example, for an epidural. Therefore, there is less risk of complications or unsuccessful puncture;

Cons and complications after spinal anesthesia

a sharp drop in blood pressure (blood pressure). In connection with this inevitable factor in the use of spinal anesthesia, a number of preventive measures are preliminarily carried out. As a rule, drugs that increase blood pressure are administered to a woman, but they can adversely affect the child's nervous system, since, by raising the mother's blood pressure to an acceptable level, they will cause increased blood pressure in the baby;
limited exposure time. If with epidural anesthesia it is possible to add anesthetics as needed, then in this case the drugs are administered once - before the start of the operation. If something goes wrong, and the operation takes longer than planned, the woman will be urgently transferred to general anesthesia. However, today drugs are used, the action of which lasts up to 2 hours;
high risk of neurological complications associated with the development of headaches.

Epidural anesthesia

Mechanism manipulations generally repeat the conduct of spinal anesthesia, however, the needle is inserted into the gap between the wall of the spinal canal and the solid wall of the spinal cord - into the epidural space, where the nerve roots exit.

A thin rubber tube is passed along the needle - catheter. The needle is removed from the puncture, and the catheter remains - pain medications are subsequently delivered through it.

The effect of anesthesia develops gradually within 20 minutes after the start of drug administration.

pros

the woman in labor is conscious and can see her baby immediately after birth;
the decrease in blood pressure occurs gradually, which allows you to maintain it normal with preventive measures;
the ability to prolong anesthesia if the operation is delayed, as well as for the postoperative period. In addition, if epidural anesthesia was used during childbirth, turning into an emergency caesarean section, it continues to be used during the operation.

Cons and complications after epidural anesthesia

in case of accidental ingestion of a large dose of anesthetics into the bloodstream, toxic poisoning may develop, up to convulsions and death;
sometimes epidural anesthesia does not work at all or works partially, for example, anaesthetizing only the left or right side;
complex manipulation requiring a certain level of skill from the anesthesiologist. This is also due to the high risk of complications due to errors in execution;
the possibility of developing a spinal block. A complication occurs when the puncture is not carried out correctly, and anesthetics are injected under the arachnoid of the spinal cord. In the event that a large dose of drugs was administered, and assistance was not provided in time, the woman may experience respiratory arrest, and then the heart;
the effect of drugs on the child;
due to late exposure to anesthetics, the start of the operation is delayed by an average of 20 minutes. A fall in blood pressure during this time can lead to prolonged fetal hypoxia.

Contraindications for regional anesthesia for caesarean section

spinal deformities and injuries;
low blood pressure;
inflammation at the puncture site;
intrauterine fetal hypoxia;
existing or suspected bleeding in the mother.

Common complications of regional anesthesia

1. When puncturing the hard shell of the spinal cord cerebrospinal fluid may leak into the epidural space. This complication after caesarean section is characterized by severe prolonged pain in the back and head. As a rule, drug treatment is carried out first, and if it does not work, a so-called "blood patch" is made.

The essence of the manipulation is that a puncture is performed again, and the woman’s own blood is injected into the epidural space in order to “seal” the puncture of the spinal membrane. Usually this procedure gives quick tangible results.

2. Probability of development prolonged positional compression syndrome. This complication after anesthesia is due to the fact that after the operation, the woman in labor does not feel her legs for some time. Sometimes it happens that when shifting it from the wheelchair to the bed, the leg is twisted.

If the medical staff did not notice this, and the leg is in an unnatural position for a long time, blood does not flow to it, and this is fraught with the development of serious consequences.

After the limb is returned to its normal position, shock and swelling will begin to develop - all this is accompanied by pain and difficulty in movement.

If you are going to have regional anesthesia for a caesarean section, be sure to reiterate to yourself the need to make sure you are placed on the bed correctly. So you will save yourself from many months of torment and the use of narcotic painkillers.

Complications of regional anesthesia for a child

So, what is the danger of lowering the mother's blood pressure during regional anesthesia for caesarean section? The fact is that in such a situation, the blood flow of the placenta is disturbed, and, as a result, the child develops hypoxia. Hypoxia (or oxygen starvation) is fraught with damage to the white matter of the brain, that is, deviations in the development of the central nervous system with all the ensuing consequences.

It is noteworthy that a newborn can show a high Apgar score, and the results of hypoxia will appear much later - by 2-3 years.

As you can see, all types of anesthesia have their advantages and disadvantages. In the article, we indicated background information in order for you to imagine what anesthesia is for a caesarean section.

However, a lot depends on your individual characteristics, qualifications of honey. personnel, drugs used, and many other factors that determine the outcome of the operation in general, and the use of anesthesia in particular. In addition, science does not stand still - new methods and drugs are constantly appearing.

Remember that you yourself can choose the type of anesthesia for a planned caesarean section, despite the fact that your choice will not contradict objective contraindications. In order to make the right decision, you should get the advice of a qualified specialist, talk to the doctor who is leading your pregnancy and the anesthesiologist.

I like!

If during pregnancy the mother has indications for surgical delivery, then she is prescribed a planned operation. It consists in removing the newborn from an incision in the abdomen and uterus. Like any abdominal operation, caesarean section requires mandatory anesthesia. Often, patients are given a choice of type of anesthesia, and many of them stop at the "epidural". Epidural anesthesia for caesarean section has specific features, advantages and disadvantages, which must be considered when choosing anesthesia.

There are several commonly accepted anesthesia options that are widely used for caesarean section. These include:

General anesthesia. With such anesthesia, the woman is in an unconscious state, she is immersed in a drug-induced sleep, in which there is no understanding of what is happening and sensitivity. In endotracheal general anesthesia, a special tube is inserted into the trachea, which communicates with the device that performs pulmonary ventilation. Such anesthesia begins to work almost instantly, so it is used when urgent surgical intervention is needed.
Spinal anesthesia belongs to the methods of regional anesthesia, which are safer for the baby and the woman in labor. Such anesthesia involves the introduction of a special anesthetic drug through the thinnest needle into the cerebral fluid of the spinal canal. The procedure is almost painless, does not cause much discomfort, except for a slight feeling of pressure. To inject the anesthetic, the woman should lie on her side, press her knees to her stomach. As a result, the mother does not experience any pain during the delivery process, she remains conscious throughout the operation, and after removing the baby, she will immediately be able to see him.
Epidural anesthesia, like spinal anesthesia, refers to regional types of anesthesia. According to the mechanism of action and conduction, it is close to spinal, although it has several differences.

Each technique is good in its own way, but there are contraindications. More often than other types, epidural anesthesia is used for caesarean section.

Epidural pain relief

Anesthesia by this method is usually used for planned delivery operations, because it begins to act gradually, 20 minutes after the puncture. Such anesthesia does not require such high professionalism and accuracy as spinal anesthesia, since the drug is injected into the epidural spinal cavity. A needle is inserted between the spinal dura and the wall of the brain canal, through which the catheter passes. Then the needle is removed, and an additional dose of anesthetic can be injected through the remaining catheter, if necessary.

It is not uncommon for epidural anesthesia to be used in traditional childbirth to eliminate pain and ease the process of natural delivery in women with overly heightened perception of pain. After the administration of the drug, the nerve roots begin to lose sensitivity, as a result, the woman soon ceases to feel the lower half of the body. Moreover, all types of sensitivity disappear: pain, thermal, tactile, etc. At the same time, the woman in labor is in a clear mind and can contact doctors. After a caesarean section, this anesthesia lasts for several more hours.

If during the epidura the anesthetic injection technique was violated, then anesthesia can only spread to half of the body. If for some reason epidural anesthesia cannot be done, then a caesarean section is performed under general anesthesia.

How anesthesia is carried out

When a woman decides on the choice of anesthesia, her preparation begins, which includes psychological work, identifying possible allergic reactions, taking sedatives, and so on. The patient must be examined: blood pressure, temperature and other health indicators are measured. A woman takes laboratory tests for determining Rhesus, blood type, hemoglobin and erythrocyte cells, leukocyte and platelet counts. Be sure to conduct a coagulogram for the concentration of prothrombin and fibrinogen.

After all the above procedures, with the approval of epidural anesthesia, they proceed directly to the operation, which begins with the work of the anesthesiologist. A catheter is inserted into a peripheral vein, an infusion system is connected, a cuff is placed to control pressure, and an oxygen mask is prepared. The woman is laid on her side and anesthesia is injected between the lumbar vertebrae, which is most often used as Lidocaine.

During the entire operation, the patient is carefully monitored, which involves monitoring respiratory functions and hemodynamic parameters such as pulse, heart rate and blood pressure. The effect of the epidura usually lasts for several hours after the operation.

Benefits of an epidural

Doctors can do this anesthesia for caesarean section in two ways: with or without a catheter. When a catheter is inserted, a small dose of anesthetic is initially injected, and then an additional dose is administered if necessary. If the catheter is not installed, then the drug is immediately injected in a large dose so that its effect is enough for the entire operation.

The use of "epidural" during surgical delivery has some advantages, for example, the absence of side oxygen starvation of the fetus and the woman in labor, which is observed during general anesthesia against the background of repeated insertion of the tracheal tube or due to an incorrectly configured pulmonary ventilation apparatus. There are other advantages of such anesthesia:

During the entire caesarean procedure, the patient is in full consciousness and understanding of what is happening around, so it remains possible to hear and see the baby immediately after it is removed;
There is no irritant associated with damage to the airways during intubation;
During the operation, relatively stable cardiovascular functioning is ensured;
The anesthetic drugs used are not capable of causing toxic harm to the fetus;
Epidura provides a sufficiently long analgesic effect, therefore it is successfully used in natural childbirth, a caesarean section is done with it, etc .;
It is allowed to use anesthesia not on an empty stomach, while with general anesthesia, abstinence from food is required.

Epidural anesthesia is very effective against postoperative pain syndrome, when appropriate drugs are injected through the catheter after the intervention, so this anesthesia is widely used in surgical practice.

When is such anesthesia indicated?

In order for a caesarean section to be performed with epidural anesthesia, a number of relevant indications are taken into account. Such anesthesia is recommended if a woman in labor has pathological abnormalities such as diabetes mellitus or preeclampsia, heart defects or hypertension, and various kidney diseases. In addition, the “epidural” is performed in a situation where, at the beginning of natural childbirth, similar anesthesia was already used for pain relief, but complications arose and the patient urgently needs to undergo a delivery operation.

Similar anesthesia is also shown in case of premature pregnancy, if the pregnant woman has hepatic disorders, with cervical pathologies or excessive uterine activity. If the general type of anesthesia is contraindicated, then the woman in labor is also performed a caesarean section with epidural anesthesia.

Epidura, in comparison with general anesthesia, is a more gentle and safe procedure for the child, but when choosing anesthesia, the specialist always assesses the general condition of the woman in labor and the fetus.

Disadvantages of epidural anesthesia

Although there are many advantages, epidural anesthesia for caesarean section has some disadvantages. Such injections help to reduce blood pressure, which in some situations can provoke a pronounced nausea attack and severe dizziness during the operation. If the technique of administering the anesthetic is not observed, convulsive seizures and a rapid decrease in pressure may occur, which is fraught with serious brain damage and even death.

It is impossible to exclude the influence of drugs on the fetus, although it does not enter the child’s body directly, it can negatively affect him through complications on the mother’s body. If, for any reason, the delivery operation is extended for more than a two-hour period, then the epidur will have to be extended, i.e., higher doses of anesthetic medication will be administered. It can also negatively affect the newborn.

Contraindications to anesthesia of this type

To avoid possible negative consequences, it is necessary to take into account some requirements for this type of anesthesia. Of course, doctors will not give such anesthesia to a woman if she herself refuses it. In addition, it is impossible to provide full-fledged epidural analgesia in the absence of the necessary equipment, materials, and also the specialization of the anesthesiologist. Also contraindications include:

Therefore, when choosing such anesthesia, it is necessary to take into account these contraindications. Otherwise, there is a high risk of developing undesirable consequences that are dangerous for the fetus and mother.

Possible adverse reactions and negative consequences

Usually, epidural anesthesia rarely causes any complications, but if the anesthesia technique is not followed, the patient may face similar consequences. A feeling of numbness, goosebumps and tingling in the limbs, which occurs in the first minutes after the administration of the medication, is considered quite natural. This is a normal reaction indicating the onset of action of the anesthetic drug. Such sensations will disappear after the cessation of the therapeutic effect of the drug. Spontaneous shivering is also considered a normal response to guidance, which subsequently resolves on its own.

If sterility is violated at the puncture site, inflammatory processes may occur, for the elimination of which the use of topical antibiotics in the form of solutions or ointments is indicated. If during the operation a woman's pressure drops sharply, then the consequences of epidural anesthesia in the form of a nausea-vomiting reaction are possible, which is eliminated by normalizing blood pressure. For this, cardiotonic drugs like Methasone or Epinephrine are prepared in advance.

Sometimes, with insufficient preoperative preparation, a woman in labor may experience a sudden allergic reaction to the anesthetic. Then it is necessary to stop its administration and stop the attack with antiallergic drugs such as Dexamethasone or Suprastin. If during the introduction the anesthesiologist mistakenly pierced the hard bone marrow, then the woman in labor will subsequently experience pronounced headaches. In such a situation, daily bed rest is necessary, it is allowed to get up only the next day. Such an appointment is due to an increase in pressure in the spinal canal in a vertical position, as a result of which fluid flows out, leading to headaches. In addition to bed rest, the use of painkillers like Analgin, etc. is indicated.

It happens that women complain of pain in the back, the causes of which are associated with traumatic damage to the spinal nerve root during the puncture process. With the erroneous introduction of an anesthetic into the vessel, the development of acute systemic intoxication is possible. To avoid this, an aspiration check is performed or a test dose is applied. According to statistics, adverse reactions or complications occur when contraindications to the use of such anesthesia are not observed.

There is no such anesthesia, which would not have any contraindications. If a cesarean is planned in advance, then the type of anesthesia is selected taking into account the wishes of the woman in labor, but contraindications and indications are also taken into account. There are specific criteria by which the most optimal pain relief is determined.

The general condition of the woman in labor and the presence of a history of certain pathologies. If the patient has reduced blood clotting or pathologies such as lumbar osteochondrosis are present, then spinal and epidural anesthesia is unacceptable. If there are cases of hyperthermia of a malignant nature in the family history of the pregnant woman, then general anesthesia is contraindicated.
Estimated duration of the procedure. If additional surgical manipulations are planned during caesarean section, then a general type of anesthesia is prescribed; for uncomplicated delivery operations, the choice remains with regional anesthesia. Epidural anesthesia provides a longer anesthetic effect than spinal, but less deep. With any regional anesthesia, a decrease in pressure is noted, which, with a long-term effect, can lead to fetal hypoxia.
Accounting for indications for a delivery operation. In case of emergency intervention, the choice falls on general anesthesia, because it acts instantly. A planned cesarean allows the use of local types of anesthesia, in which the woman will be conscious, so that she can see the baby immediately after extraction and hear his first cries.

Local methods of anesthesia are less dangerous for the patient and the baby, but the final choice is determined jointly with the doctor on the basis of a specific case.

What do the doctor's say

Doctors insist that epidural anesthesia is permissible only if indicated. Today, many patients, because of the rhinestone before childbirth, literally require similar anesthesia during natural, uncomplicated childbirth. Usually, women in labor begin to require pain relief when the delivery is almost over. And at this time, anesthesia is categorically unacceptable, since anesthesia will negatively affect contractions, and the woman in labor will not be able to push the baby out on her own.

Epidural anesthesia is more of a surgical intervention in the spinal structures, rather than a harmless anesthetic injection. Even with the availability of modern safe, reliable and improved medical technologies, the possibility of complications cannot be ruled out. Therefore, epidural anesthesia is the optimal method of anesthesia for caesarean section, but it is better to refuse it during natural childbirth.

If for some reason a pregnant woman has to give birth surgically (through a caesarean section), then one of the most important issues will be the choice of the method for performing such an operation, more precisely, the method of anesthesia.

Today, obstetricians use three types of anesthesia during cesarean birth: general anesthesia, epidural and spinal anesthesia. The first is resorted to less and less as an outdated method, but there are situations when it is the only possible way of pain relief. Preference today is given to two other types of anesthesia as safer and easier in terms of implementation and in terms of "departure" from anesthesia. They have other advantages, as well as disadvantages, of course.

The decision on the method of conducting a CS (caesarean section) is made by the doctor together with the patient. In many respects, it depends on the state of health of the mother and the unborn child and on the characteristics of the course of this pregnancy. But the desire of the woman in labor also plays an important role.

Today we offer a closer look at spinal anesthesia in childbirth, since among all types it is the highest priority for Western, and domestic doctors too.

Spinal anesthesia for caesarean section: pros and cons, consequences, contraindications

Like epidural, spinal (or spinal) anesthesia refers to regional anesthesia, that is, a method of anesthesia in which the sensitivity of a certain group of nerve impulses is blocked - and the effect of anesthesia occurs in the part of the body necessary for medical manipulations. In this case, the lower part of the body “turns off”: the woman does not feel pain below the waist, which is enough for painless comfortable childbirth and unimpeded comfortable work of doctors.

The great advantage of regional anesthesia is that the mother remains conscious, can think and speak clearly, understands what is happening to her and is able to see, pick up and even attach a newborn baby to her breast immediately in the first minutes of his life.

If we talk specifically about the spinal method of administering an anesthetic, then it has such advantages compared to other methods:

Rapid onset of action. Drugs administered for pain relief during spinal anesthesia begin to act immediately. About two minutes - and doctors can already prepare the abdominal cavity for surgical intervention. This is of particular importance when CS has to be performed unscheduled, on an emergency basis: in this case, spinal anesthesia is a priority choice and life-saving remedy.
Very effective pain relief. The analgesic effect reaches 100%! This is a big plus not only for the woman in labor, who participates in the process, but does not feel pain, but even a huge advantage for obstetricians who can do their work in comfortable conditions. This requires less than with epidural anesthesia, the amount of anesthetic drugs.
No toxic effects on the mother's body. Unlike other methods, this one is quite gentle in terms of negative effects on the woman's body. In particular, intoxication of the central nervous and cardiovascular systems is minimized.
Minimal risks to the fetus. With a correctly selected and administered dose of anesthetic, the baby does not experience any negative effect of the drug, the respiratory centers of the baby (as with other types of anesthesia) in this case are not oppressed. It is for this that the majority of women in labor who are due to give birth by CS are worried.
Ease of carrying out. The choice of a qualified specialist is of paramount importance, and in this regard, a woman will have fewer fears and worries, because spinal anesthesia is easier to perform. In particular, the anesthesiologist has the ability to feel the "stop" of the needle, so there is no risk of inserting it deeper than is acceptable.
Application of a fine needle. The needle itself is thinner than that used for epidural anesthesia. This allows pain relief with a single injection of the drug without placing a catheter (as with an "epidural").
Minimal postoperative complications. After a few days (and sometimes even hours), the newly-made mother can lead a normal life - move, get up, take care of the child. The recovery period is very short and easy. The resulting consequences in the form of headache or back pain are minor and short-lived.

Meanwhile, spinal anesthesia also has disadvantages:

Short duration. The blockade of nerve impulses that transmit pain persists for several hours (from one to four depending on the type of drug, but on average within two hours) from the moment the drug is administered. Usually this is enough to safely take delivery. But in some cases, a longer time is required. If such situations are known in advance, then another type of anesthesia is preferred.
Possibility of complications. In this case, much depends on the professionalism of the anesthetist and obstetric staff. But even with a quality work done, some complications are not excluded, because each organism individually reacts to such interventions and influences. In particular, so-called post-puncture headaches often occur (in the temples and forehead), which can persist for several days; sometimes loss of sensation in the legs persists for some period and after the operation is completed. It is also important to prepare for spinal anesthesia, in particular, to introduce drugs that prevent a strong sharp drop in blood pressure, which occurs very often during spinal anesthesia. If the dose of the anesthetic was calculated inaccurately, then it is no longer possible to administer the drug additionally, otherwise neurological complications are possible.
Presence of contraindications. Unfortunately, this type of anesthesia is not always applicable. It is impossible to resort to spinal anesthesia in cases where there are complications and circumstances requiring a longer action of anesthesia, and when the woman took anticoagulants on the eve of childbirth. Among the contraindications to spinal anesthesia are any blood clotting disorders, severe cardiac pathologies, dysfunctions of the central nervous system, exacerbation of herpes infection and other infectious and inflammatory processes, high intracranial pressure, patient disagreement, fetal hypoxia. Do not perform such an operation with a large loss of fluid or blood by a woman.

Despite the presence of some disadvantages, this type of anesthesia for cesarean section is the most beneficial in many respects, including from a financial point of view: spinal anesthesia is cheaper than epidural.

Spinal anesthesia technique for caesarean section

As we have already noted, the technique of such anesthesia is simple to perform. The specialist, using a very thin needle, makes a puncture in the lumbar region (between the vertebrae) and injects an anesthetic into the subarachnoid space - into the cerebrospinal fluid that fills the spinal canal. Thus, the sensitivity of the nerve fibers passing here is blocked - and the lower part of the body is “frozen”.

Spinal anesthesia requires a puncture of the membrane surrounding the spinal cord. This shell is quite dense, that is, the anesthesiologist feels the moment of its puncture, which allows him to accurately determine when the needle "entered" the right place and avoid unwanted complications.

Preparations for spinal anesthesia are administered to a woman in labor in a position on her side (more often on the right), but it is also possible while sitting. At the same time, it is very desirable that she press her legs bent at the knees as high as possible to her stomach.

A woman at the time of the injection of the drug practically does not feel pain, except for a slight, very short-term discomfort. Soon a feeling of numbness of the lower extremities sets in - and the operation begins.

It should be mentioned that during the planned CS with spinal anesthesia, some preparation is required, which the woman in labor will certainly be told about. In particular, on the eve of the operation, you can not drink and eat, take sedatives and blood-thinning drugs. After the operation, you will need to stay in bed for a while and drink plenty of water. If necessary (according to the results of a study of the condition of the woman in labor), medications are prescribed to relieve unwanted symptoms (nausea, itching, urinary retention, chills, etc.).

Feelings during spinal anesthesia: reviews

No matter how much we study the theory, not least we are also interested in practice. And so women go to the forum and ask women who have already given birth in this way a lot of questions: how does a caesarean section work with spinal anesthesia, does it hurt, is it dangerous, is it scary, what effect does it have on the child, and so on.

You can easily find on the net a lot of reviews, descriptions and even whole stories about how a particular woman gave birth, including with the use of spinal anesthesia. They talk in detail about everything: what sensations they experienced at the time of the injection of the medicine, how long the birth lasted, how they felt the next and a few days after the operation.

But if all this is summed up, then the main conclusions, according to the stories of women, will be the following:

The biggest disadvantage of spinal anesthesia for CS is fear. It’s just scary, because it’s still an operation, it’s still anesthesia, it’s still unknown (how everything will go, how the body will react, how the doctors will work). In practice, it turns out that everything ends wonderfully! Women are very happy with such childbirth. But fear is inevitable for many.
Very often, after the introduction of an anesthetic, there is a sharp drop in blood pressure - shortness of breath occurs, it becomes very difficult to breathe. This is not dangerous: doctors immediately give the woman in labor an oxygen mask and administer medications - and her condition quickly stabilizes. If you use drugs for prophylactic purposes, then such side effects can be completely avoided. The same applies to sedatives: taking them in advance allows you to avoid "shaking" during and after such childbirth.
Quite often, after such childbirth, mothers suffer from back pain, and they even have to resort to painkillers. But such pain after cesarean does not always appear, it is not always very strong, and, as a rule, it lasts no more than 2-3 days.
Even for some time after the operation, sometimes there may be attacks of trembling, aching pain at the injection site, numbness.

Individual reactions to anesthetics are never excluded. In isolated cases, women note a burning sensation in the lower extremities, loss of sensitivity in them for a long time after surgery, persistence of headaches, especially in an upright position, vomiting after surgery, and poor tolerance to low temperatures. But these are all exceptional cases. However, if numbness or pain at the injection site persists for more than a day after CS, then this should definitely be reported to the doctors.

In general, women who have experienced spinal anesthesia during caesarean section note that it does not hurt, the postoperative period is quite favorable, and that they do not find any special negative points in this, being satisfied with the results. Especially those who have something to compare with, that is, in which the previous birth took place under general anesthesia.

And therefore, if such childbirth is coming to you, then there are no reasons for unrest. If operative delivery is inevitable, then spinal anesthesia for caesarean section in the absence of contraindications is really the best solution.

Good luck to you!

Especially for - Margarita SOLOVIEVA

A caesarean section is a surgical delivery in which the baby is removed through an incision in the mother's uterus. Distinguish between planned caesarean section and emergency. I have gone through two such operations, as a result of which I have two wonderful daughters. I had a planned caesarean section due to high myopia. If myopia entails changes in the retina, then a caesarean section is the only way to deliver. My first birth took place under general anesthesia, the second under spinal anesthesia. I'll tell you in detail about my feelings.

General anesthesia for caesarean section

They put me in the hospital a week before giving birth. Here they gave me droppers, gave me vitamins, followed the tests. In general, they prepared for the operation. I gave birth in the countryside, so the choice of anesthesia was small, or rather, it did not exist at all. The day before the operation, the anesthesiologist called me for a conversation and warned me that only general anesthesia is done in this hospital. Roughly speaking, they will put me to sleep, and I will wake up already in the ward, becoming a mother. Before the operation, I passed control tests, underwent an unpleasant procedure with an enema. And here I am in the operating room. Sensors were attached to one arm to monitor my pulse and blood pressure, and a catheter was inserted into the other arm. I felt like a flattened dissected frog. It was very scary. I was afraid not to fall asleep and feel everything, I was afraid not to wake up at all. The fear of the unknown was scary! Before the start, they gave me oxygen to breathe with the help of a mask, and then anesthesia was introduced into the vein through the catheter. After a couple of minutes, the ceiling began to blur above me. The sensations are very unpleasant and strange. It’s as if I’m flying into some kind of tunnel, and around me I’m crushed by an incomprehensible white sticky mass. I hear some kind of growing rumble and I really want to get out of here, but I can’t.

And then I opened my eyes. I came to consciousness badly. There was a strong weakness, dizziness, pressure dropped to 70/40. I was very thirsty. I didn't feel any pain because I was given painkillers. And I also wanted to know what was happening with the child, how was he. I fully recovered from anesthesia only in the evening.

The child was born healthy. Closer to the night they brought me and showed me. I didn't get out of bed for days. The pain in the area of the seam was quite tolerable. On the second day, I completely refused painkillers. I got up only on the third day. But in vain! The sooner you get up, the sooner everything will heal. She walked slowly, in a half-bent state. The child was given to me on the fourth day. By this time, she was used to eating formula and did not breastfeed. I taught her long and painfully for three months. As for my suture, on the seventh day, on the day of discharge, I no longer thought about it. Everything healed very quickly.

My second epidural birth

My second operation took place seven years later. This time I was advised local anesthesia, as it is more gentle. The beginning was the same as the first time: tests, an enema, an operating room. They made an injection in the lower part of the spine. It does not hurt. A curtain was hung in front of me so that I could not see the actions of the doctors. I felt my lower body go numb. How I was cut, I did not feel. Only when the child was taken out did I get the feeling that something was being pulled out of me, but there was no pain. And then I heard the cry of my baby. This is such happiness! All mothers will understand me. This is an unforgettable moment. I wept with great joy. My daughter was shown to me right away. The whole operation took 40 minutes. At the end, I was given a sedative injection and taken to the ward. I immediately called all my relatives and told the good news. After the operation, I was very shivering, but it is tolerable. Ice was applied to the seam and an anesthetic was injected. I began to feel the lower part of the body after three hours. In the evening they lifted me out of bed, and I tried to disperse. On the second day they gave me the baby, and I breastfed without any problems. The seam hurt for five days. Longer than the first time. But a week later, I happily forgot about it.

To summarize, I want to say that if you are given the choice of anesthesia, then choose only spinal anesthesia. It is much easier to carry, you are conscious all the time of the operation. You have the opportunity to see the child and be aware of everything that happens. This anesthesia is absolutely harmless to the baby.

Recovery after cesarean

After a caesarean section, the most important thing is to get out of bed as soon as possible. Let it hurt, hard, dizzy, but you have to overcome, force yourself. Otherwise, the seam will heal slowly, and adhesions will still form. Do you need it? As soon as you come to your senses, try not to lie on your back all the time, but turn on one side, then on the other. And after six hours, slowly rise. Do not hurry! Sit on the bed for five minutes, and then with the help of one of your relatives, take a couple of steps. Walk a little, lie down, rest. I know for myself that I really want to lie down, but I have to overcome myself. It is very important to disperse in the first days. Thanks to this, you will walk without problems already on the third day after the operation. When you breastfeed, you will feel pain in the uterus and increased bleeding. This is fine! When a baby suckles at the breast, uterine contractions occur. Be sure to wear a bandage. With it, there will be no pressure on the seam, and it will heal faster. After discharge, process the seam with brilliant green for five days. I swam on the second day after the operation. After six months, you can go in for sports.

Restoring the shape after a caesarean section is slower, as the abdominal muscles are cut. It took me two years. But thanks to these operations, I have two wonderful daughters, I have no deterioration in vision, and I don’t even remember the operations. The seam has long healed and turned pale. You can't see it under underwear at all. Giving birth through surgery is not scary. The main thing is to think about your baby. Health to you and your children!