How is caesarean performed under spinal anesthesia? What anesthesia is better to choose for a caesarean section? The difference between epidural anesthesia and spinal anesthesia

Many patients, when preparing for planned operations, are interested in what the consequences of epidural anesthesia during childbirth may be. After all, this method of pain relief is still little known to ordinary people.

The epidural space in humans is located along spinal column. It envelops the hard protective sheath of the nerve roots and directly spinal cord.

Epidural (peridural) anesthesia helps block the transmission of nerve impulses at the location of the nerve roots. As a result, a decrease in intensity or complete suppression of pain is achieved. The anesthetic is administered directly into the epidural area (space) using a specially designed catheter.

Such anesthesia is performed by administering various painkillers. This allows the procedure to be performed with varying degrees of effect.

Analgesia leads to loss of pain sensation. Anesthesia is necessary for complete loss of sensation. Muscle relaxation is performed to relax muscle tissue and reduce pain intensity.

Indications for epidural anesthesia during childbirth

Epidural anesthesia is a medical procedure that poses a certain degree of danger to the patient. Peridural anesthesia can cause side effects, has contraindications and is fraught with negative consequences. Only an experienced specialist should administer the drug.

Preliminarily carried out full examination patient, careful examination of the history and results laboratory research. Based on the data obtained, the anesthesiologist and the specialist performing the primary treatment of the patient make a decision on the admissibility of the procedure in a particular case.

Such anesthesia is sometimes prescribed during obstetrics (especially when caesarean section), with urological and gynecological operations. Spinal anesthesia is also used for surgery in the area lower limbs, perineum, pelvic organs.

Drugs used

Involves application various drugs to achieve the desired effect. All injected solutions undergo intensive purification and are freed from preservatives. This increases their effectiveness and safety for the patient.

The main drugs for epidural anesthesia are local anesthetics:

bupivacaine;
lidocaine;
ropivacaine.

To intensify the analgesic effect, opiates are additionally used:

buprenorphine;
morphine;
promedol;
fentanyl.

IN special cases The following are added to the solution for epidural administration: medical supplies, How:

clonidine;
ketamine;
physostigmine.

The specific composition of the injected solution is determined strictly individually. Its dosage is selected at the rate of 1 or 2 ml of liquid per individual segment of the spinal cord that needs to be blocked. Defining Moments - clinical picture and the patient's health status.

Contraindications to the procedure

The main contraindications to the use of epidural anesthesia are:

Possible consequences

Spinal epidural anesthesia causes various consequences that pose a danger to the patient's body. Some of them can be predicted in advance. Then it is better to refuse this type of pain relief. Some complications arise unexpectedly and for no apparent reason.

The degree of danger in a particular case is determined by factors such as:

age and general state patient;
composition of the anesthetic solution;
correct procedure.

Basic Negative consequences similar anesthesia is:

Some consequences gradually disappear as the body is resuscitated postoperatively. Dangerous complications require special treatment.

Epidural anesthesia for caesarean section

Such anesthesia is increasingly used during obstetrics, relieving the young mother of the pain caused by the birth of a child. Epidural anesthesia for caesarean section, planned or emergency, is preferable to general anesthesia. The woman in labor remains fully conscious.

She can see her baby immediately after birth and hear his first cry. Therefore, many expectant mothers who are prescribed to give birth by caesarean section ask to replace general anesthesia for epidural anesthesia.

The final decision is made, of course, by specialists: obstetricians, anesthesiologists, pediatricians. After all, complications after epidural anesthesia are possible not only for the woman in labor, but also for the baby.

Consequences of epidural anesthesia during childbirth

If the required dose of anesthetic is exceeded, a woman in labor may experience:

toxic effects on the brain;
a sharp decline blood pressure;
development of convulsive syndrome;
respiratory disorder;
heart failure.

If the specialist administering the anesthetic is not highly qualified, the needle or catheter used during the procedure may injure the nerve roots of the spinal cord. If the required level of sterility is not observed around the injection site, infection begins and inflammatory process. Very often in such a situation, septic meningitis begins.

A sharp decrease in blood pressure causes general weakness, nausea, and vomiting. In this case, to stabilize the condition, it is enough to correct the pressure with the help of special medications.
If there is an error in administering the anesthetic, the dura mater of the spinal cord may be punctured. This causes severe post-puncture headaches and general weakness. Therefore it is prescribed bed rest and absolute peace for at least a day.

When a significant dose of anesthetic solution enters a blood vessel, severe intrasystemic intoxication occurs. Injury to the spinal cord roots leads to the development of severe pain in the back and spine. In this case, it is also possible to limit physical activity.

Epidural anesthesia during childbirth - consequences for the child

results special research It is not yet possible to give a definite answer to the question about the danger of the influence of epidural anesthesia for a child. The main factors that can cause negative consequences are:

It is reliably known that an epidural anesthetic administered to a young mother during natural childbirth noticeably reduces the child’s activity. This makes it difficult for him to be born, reduces the rate of passage of the fetus through birth canal. In this case, there is a need to use vacuum extraction, forceps and other methods of assisting during childbirth. This may cause serious injuries in a newborn.

If, after the administration of an anesthetic solution, a woman begins to tremble severely, the child experiences a significant lack of oxygen. Further dangerous consequences Epidural anesthesia leads to various kinds of problems with breastfeeding.

Complications of epidural anesthesia during abdominal surgery

The use of epidural anesthesia during surgery is carried out to partially relieve pain in certain areas of the patient’s body, in addition to general anesthesia and to relieve postoperative pain. Anesthetics, opioids and other drugs used for anesthesia may have side effect on the patient's body. Specific complications in this case depend on the violation of the dosage, improper implementation of the procedure, and individual characteristics of the health status.

Many complications that appear after epidural pain relief go away over time without treatment or are easily eliminated with the help of medical supplies. These include:

shiver;
itching and goosebumps all over the body;
drop in blood pressure;
partial or complete immobility;
back pain;
partial numbness or loss of sensation in case of damage to nerve fibers.

Serious problems are caused by a break in the catheter through which the anesthetic is administered. In this case, it is necessary to carry out special surgical intervention to remove the broken end stuck in the spinal canal.

An error when administering an epidural injection, leading to bone injury, subsequently causes severe pain in the spine and back area. To eliminate them, a special course of treatment is required.

Headaches after epidural anesthesia can have a different threshold of intensity. If they occur as a side effect of the administered anesthetic, then they are easy to stop. Over time, the syndrome goes away. In the case when the epidural needle pierces the dura spinal cord, in order to relieve the patient of headaches, the puncture has to be repeated. When an accidental puncture is blocked, pain syndrome will gradually pass.

Any convulsions and difficulties in performing natural functions (especially when urinating) can be eliminated by taking appropriate medications. Additionally, a course of physiotherapy and other healing procedures is prescribed.

There are many indicators to measure surgery called a caesarean section, in which the fetus is removed from the mother's womb through an incision in abdominal wall uterus, namely:

health of the expectant mother;
problems during pregnancy;
condition of the fetus.

There is also more than one method of anesthesia for it (today, general and spinal anesthesia are used).

In the majority foreign countries births by caesarean section are carried out under epidural or spinal anesthesia, but attention should be paid to the fact that the rate of use of the latter is constantly growing and often dominates over epidural.

Each method is “endowed” with its own advantages and disadvantages, and, therefore, indications and contraindications as well (the doctor must take all this into account when choosing a method of pain relief). Today we will talk in more detail about spinal (or spinal) anesthesia.

The introduction of an anesthetic between the vertebrae in the lumbar region of the back (in the subarachnoid space) is called spinal. With this method of pain relief, a puncture is made in the dense membrane that surrounds the spinal cord (compared to epidural anesthesia in in this case the needle is inserted a little deeper), that is, the puncture site is lumbar region. Injected into the cerebrospinal fluid through a needle local anesthetic, which fills the spinal canal, as a result of which any manifestations of sensitivity are “blocked” in this area.

Most often, a puncture (puncture) of the spinal space is performed while lying on the side, and if the woman in labor has the opportunity, it would be advisable to tuck her legs towards her stomach. Less commonly, the procedure is performed in a sitting position.

Benefits of spinal anesthesia for caesarean section

the woman in labor is fully conscious;
rapid onset of anesthesia, which is very necessary in emergency situations in case of emergency;
100% pain relief;
you can begin preparing for surgery (processing abdominal cavity) already 2 minutes after the administration of the anesthetic;
due to the fact that with spinal anesthesia it is possible to accurately determine the location of the needle insertion, it is easier to perform in terms of technique than general or epidural;
Compared to epidural anesthesia, in this case a thinner needle is used to administer an anesthetic;
absence toxic reactions from the outside of cardio-vascular system or the central nervous system (as is possible with epidural anesthesia);
there may be a very slight effect on the fetus of the anesthetic administered in small volumes - only about 4 ml;
Thanks to the fact that the muscles achieve complete relaxation, the surgeon receives excellent conditions for his work.

Disadvantages of spinal anesthesia for caesarean section

the occurrence of moderate post-puncture headache lasting 1-3 days in the frontotemporal region (the frequency of its occurrence largely depends on the experience of physicians);
the duration of the blockade lasts only 2 hours, which in principle is sufficient to carry out the entire operation;
if not all preventive measures have been taken, a decrease may occur due to abrupt start actions;
More serious neurological complications may also occur in cases where the effect of spinal anesthesia has been prolonged. If the catheter was not positioned correctly, damage to the cauda equina (continuation of the nerve roots of the spinal cord, which begin from the lumbar segments) is possible. Incorrect insertion of the catheter requires additional doses of anesthetic, which can provoke a prolonged blockade;
in cases where the total dose of anesthetic was incorrectly calculated, additional injections cannot be performed. The catheter should be reinserted to help avoid complications such as spinal cord injury due to rupture or stretching.

And yet, spinal anesthesia has less effect than others on the fetus, guarantees higher protection of the body from postoperative pain, and it is comparatively cheaper. In many developed countries spinal anesthesia for caesarean section (along with epidural) is widespread and fairly recognized safe method pain relief (many doctors have recognized it the best technology pain relief).

Especially for Anna Zhirko

If contraindications to natural childbirth are identified during pregnancy, an operation called a cesarean section is performed. The baby is removed from the uterine cavity through a hole made in the peritoneum. Like other types of abdominal surgery, the procedure requires pain relief. An epidural or caesarean section has both positive and negative features that need to be taken into account. They are different in principle of action and possible adverse reactions body. What is best is decided by the doctor in each individual case. Epidurals, compared to spinal anesthesia, are in great demand.

How epidural anesthesia works

Epidural anesthesia for caesarean section is carried out as planned. Sometimes it is urgently used during traditional labor. This type of pain relief helps reduce the sensitivity of nerve receptors, which provokes total loss sensitivity of the lower extremities.

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During a caesarean section, the analgesic effect lasts for several hours. If a woman has contraindications to this type of anesthesia, general anesthesia is performed.

As soon as the needle enters the epidural area, it moves away meninges. The anesthetic substance is introduced gradually, starting with a dosage of 5 ml. The drug blocks the transmission of pain impulses located in the spinal cord. As a result painful sensations disappear. The area below the waist is completely numb.

The difference between epidural anesthesia and spinal anesthesia

Many people mistake epidural anesthesia for spinal anesthesia. There is a big difference between these types of pain relief. The main difference is the speed of onset of the effect. When performing spinal anesthesia, the lower area of the body becomes numb no later than 10 minutes after the injection. It is not individual sections of the spinal cord that are blocked, but its entire area.

Epidural anesthesia and spinal

Drugs used

Anesthetics used for elective surgery by delivery, are classified according to the principle of impact on the body and the duration of the effect. Supplementing such drugs with Epinephrine can increase anesthesia for several hours. Before administering drugs, you must ensure that there is no allergic reaction.

The most common drugs with an analgesic effect include:

Bupivacaine . Belongs to the category of aminoamides. During surgery, it is used in a concentration of 0.125 to 0.25%.
Ropivacaine . It differs from the previous anesthetic in reduced effectiveness. When performing a surgical operation, it is used in dosages of 0.5, 0.75 and 1%.
Lidocaine . The action is based on the aminoamide content. When performing epidural anesthesia, a dosage of 2 or 1.5% is administered. Without combining with other drugs, Lidocaine provides pain relief lasting from 60 to 100 minutes. When combined with other anesthetics, its effect is prolonged by 50%.
Chloroprocaine . At surgical intervention applied at a concentration of 30%.

How is the anesthetic administered?

The procedure for administering the anesthetic is carried out while in a sitting or reclining position. According to the principle of implementation, it resembles a puncture. The difference is that no biomaterial is collected. The area where the needle is inserted is pre-treated with an antiseptic. The injection is given into the cerebrospinal fluid located in the spinal region. A needle is used for this; its length is 9 mm and its diameter is 2 mm. Then a catheter is attached to the needle, through which medicine. After completing the infusion of the solution, the catheter is removed and the needle is left in place. This is necessary so that medicine can be added during basic manipulations.

Administration of anesthetic

The required effect after pain relief is achieved within 20 minutes. There is a loss tactile, tactile and pain sensitivity. The woman is fully conscious. This is necessary to be able to contact medical personnel.

Contraindications

Before using epidural anesthesia, you should familiarize yourself with the list of contraindications. Their presence is determined in advance, as part of a preventive examination of the body.

A woman in labor should refuse this type of anesthesia in the following cases:

oxygen starvation of the fetus;
diseases of the central nervous system;
heavy bleeding;
lack of tools and equipment for the procedure;
individual intolerance to anesthetic;
blood clotting abnormalities (or taking medications that affect blood viscosity the day before);
infectious diseases in acute form.

If you do not take into account a woman’s tendency to bleed, there is a risk of significant blood loss. When the fetus is oxygen starved, anesthesia aggravates the current situation, causing various complications, up to the death of brain cells. In case of an allergic reaction, there is a risk of developing Quincke's edema. It is accompanied by rapid swelling that covers Airways. The danger of this phenomenon lies in increased risk fatal outcome.

pros

Epidural anesthesia is in demand due to a number of advantages over other types of pain relief. These include the following:

At the moment the child is born, the woman is conscious. This helps doctors monitor her condition during the caesarean section.
The epidural has a long-lasting effect. The woman does not feel the lower part of the body from 1 to 4 hours.
No irritation respiratory organs which occurs during inhalation anesthesia.
If anesthesia is used during natural labor, a woman can save strength during the most painful contractions. This in a positive way affects the outcome of childbirth.
The process of recovery from the state of anesthesia is quite fast. Within a day after the operation, the woman can perform physical activity.
It is allowed to carry out the anesthesia procedure on a full stomach. Under general anesthesia, patients are prohibited from eating on the day of surgery.
The drugs used during anesthesia do not have a toxic effect on the fetus.
Due to the fact that doctors perform epidural anesthesia in doses, there is no effect on the functioning of the cardiovascular system.

Despite the abundance of positive features, the anesthesia procedure is not safe. The disadvantages of the method include the possibility of errors during execution. The drug should only be administered by a qualified specialist.

Flaws

Women who are about to have a cesarean section are primarily interested in whether the injection hurts. There is no clear answer to this question. It all depends on the degree of height pain threshold women in labor. According to reviews, the pain from contractions outweighs the intensity of the discomfort that appears at the moment the needle is inserted.

Besides discomfort, the following disadvantages of the procedure are highlighted:

This type of pain relief can cause an increase in blood pressure, which causes nausea and dizziness.
If the medication administration technique is violated, there is a risk of developing seizures and damage to brain cells as a result. sharp jump pressure.
It is impossible to calculate in advance how long the operation will take. If the effect of the anesthetic wears off before the baby is born, the woman will have to be urgently transferred to general anesthesia. This comes with certain risks.
After epidural anesthesia, there is a possibility of neurological disorders occurring. In most cases they appear. This is due to hitting cerebrospinal fluid into an area where it shouldn't be.
Having a caesarean section under epidural anesthesia causes psychological discomfort in most women. The operation can leave an imprint on the mental state, provoking the development of various disorders.

In rare cases, incomplete pain relief occurs, which causes discomfort both for the woman in labor and for doctors. There is also the possibility of neurological abnormalities, which include paralysis of the limbs and other undesirable complications. This is possible in case of accidental injury to a nerve root. A qualified anesthesiologist will not encounter such problems. Therefore, attention should be paid Special attention choice of doctor.

Risks

Spinal or epidural anesthesia carries risks. If not met sanitary standards, there is a possibility of inflammation developing as a result of infection. This threatens health complications. The use of anesthesia may be accompanied by nausea, spontaneous tremors, dizziness and loss of consciousness. These side effects can affect the course of the operation. No one is immune from developing an allergic reaction. Therefore, it is extremely important that the injection process is carried out in accordance with established standards.

It is impossible to predict in advance how the body will react to the introduction of an anesthetic. There have been cases when numbness was noted only on one side of the body. In some cases, women felt discomfort during the operation. There is also a risk of losing consciousness during the procedure due to excessive anxiety.

Complications after epidural anesthesia

Epidural anesthesia given before a cesarean section leads to various undesirable consequences. A new mother does not encounter them immediately, but after some time. The likelihood of their development increases if childbirth is accompanied by complications.

Immediately after emerging from anesthesia, a woman’s consciousness may be slightly clouded. In the first hours after surgery, there is muscle weakness and decreased tactile sensitivity. In some cases, there are difficulties with urination.

The most common complications include pain in the back or head. This happens when the injection technique is violated or due to accidental contact with nerve receptors. There may also be problems with respiratory system. They arise as a result of contact medicinal substance under the arachnoid surface of the spinal cord.

Anesthesia is dangerous not only for the woman, but also for her child. Due to the fact that the process of childbirth is unnatural, the baby’s adaptation to the world around him slows down. As a result of the administration of the anesthetic, the child is born insufficiently active. The risk of formation increases hypoxia, which provokes various developmental deviations. It is noteworthy that Apgar scores can be quite high. The consequences of anesthesia become known as the child grows older.

Price

In every medical institution certain prices for the service are set. The final cost depends on the dosage of the administered drug. On average, the anesthesia procedure costs 3,000-5,000 rubles. If indicated, childbirth can be anesthetized free of charge, according to insurance policy. If a woman expresses a desire for anesthesia in the absence of compelling reasons, she must pay for the service in full.

Doctors' opinion

Doctors say that epidural anesthesia for caesarean section is a necessary component. Before using it, it is extremely important to weigh the risks and exclude the presence of contraindications. This will avoid unintended consequences. There is no clear answer to the question “which anesthesia is better for caesarean section”. The choice of anesthesia is made on an individual basis.

General anesthesia for caesarean section is performed in the following cases:

the woman is obese;
atypical position of the fetus in the womb;
diagnosing oxygen starvation The child has;
the presence of one or more contraindications to other types of anesthesia;
spontaneous deterioration of the patient's condition during a surgical procedure.

When choosing anesthesia, the woman’s health condition is taken into account. Her preferences are the last thing to be paid attention to. If a woman has nervous disorders, her response to an epidural can be unpredictable. Excessive emotionality during surgery can interfere with doctors. In this case the best option there will be general anesthesia.

For a child, epidural anesthesia is more preferable. Immediately after his birth, contact is established with his mother, who is conscious. This has a positive effect on milk production and the baby’s speed of adaptation to new conditions.

During natural delivery, it is recommended to use anesthesia only if indicated. If childbirth is not complicated, there is no need for anesthesia. Anesthesia can negatively affect contractions, which will prevent the woman in labor from pushing the baby out.

Conclusion

The choice of method of pain relief for caesarean section is made by the doctor. Epidural anesthesia has many advantages. But before doing it, you should study the disadvantages. Spinal anesthesia is used even less frequently than epidural. This is due to the complexity of implementation and the principle of impact on the human body.

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In certain cases, childbirth cannot proceed naturally, and then an operation is performed - the newborn is removed from the mother's womb through an incision made in the uterus. Without anesthesia, it is impossible, like any other surgical intervention. Therefore, the question of which anesthesia for caesarean section is better is very relevant.

If the operation is planned, the doctor discusses the choice of pain relief with the patient, offering his options. If you had to perform an emergency caesarean procedure, the doctor makes his own decision. Today, general (including endotracheal) anesthesia and regional (spinal, epidural, spino-epidural) anesthesia are used.

Modern surgeons and anesthesiologists do not welcome, but are still sometimes forced to perform intravenous general anesthesia during a caesarean section, which does not have the most favorable effect on the fetus and the woman in labor.

This is an artificially induced inhibition of the central nervous system, which is accompanied by sleep, loss of consciousness and memory, muscle relaxation, a decrease in some reflexes, and the disappearance of pain sensitivity. This condition is a consequence of the administration of general anesthetics, the doses and combinations of which are individually selected by the anesthesiologist.

Indications

The doctor prescribes a caesarean section under general anesthesia intravenously in the following cases:

there are contraindications to spinal and epidural anesthesia: coagulopathy, acute bleeding, thrombocytopenia;
oblique or transverse position of the fetus;
morbid obesity;
umbilical cord prolapse;
placenta accreta;
previous spinal surgery;
refusal of the woman in labor to receive regional anesthesia;
emergency caesarean section.

If these indications exist, a cesarean section is performed under intravenous general anesthesia.

Advantages

Despite the fact that most clinics today have abandoned the use of intravenous general anesthesia when performing a cesarean section, it still has a number of advantages. These include:

complete pain relief;
maximum muscle relaxation, which is very convenient for the surgeon;
rapid action of anesthetics, which allows the operation to be performed instantly, when every minute counts;
does not affect cardiac activity;
does not provoke a drop in pressure;
the doctor constantly monitors the depth and duration of anesthesia;
the technique of administering drugs for general anesthesia is extremely simple, medical errors excluded, no expensive equipment required.

Despite these benefits, intravenous general anesthesia is rarely offered to women undergoing cesarean section. Like any other anesthesia, this one has its pros and cons, and the latter are often decisive for refusing this type of anesthesia.

Flaws

Doctors do not hide the fact that the consequences of general anesthesia intravenously during a cesarean section can be dangerous to the health and even the life of the baby. It is because of this that it is abandoned in favor of spinal or epidural anesthesia.

The obvious disadvantages of this procedure include:

high risk of complications;
breathing problems in the baby;
depressing effect on nervous system the fetus, which will be expressed in its excessive lethargy, lethargy, drowsiness, whereas at such a moment it is required to be active;
aspiration - release of stomach contents into the trachea;
hypoxia in a woman in labor;
when connected to a ventilator ( artificial ventilation lungs), a woman in labor may experience increased blood pressure and increased heart rate.

The risk of future health complications for the baby is too great if a caesarean section is performed under intravenous general anesthesia. And this is the main disadvantage of this type of anesthesia, which negates all its positive aspects.

Therefore, doctors dissuade women in labor from this technique and resort to it themselves only in the most emergency cases. So be sure to find out what kind of anesthesia is used for a caesarean section in the hospital where you will have the operation.

This is interesting! Scientists from the USA have found that the state of a person under anesthesia is more equivalent to a coma than to sleep.

Endotracheal general anesthesia

TO general anesthesia This also includes endotracheal anesthesia, which is used in case of caesarean section. The pain-relieving drug enters the body's cells through a tube that the anesthesiologist inserts into the trachea. Most doctors, if delivery surgery cannot be avoided, choose this technique. Her indications are exactly the same as those of the general intravenous anesthesia, but there are many more advantages.

pros

Doctors prefer endotracheal general anesthesia when performing a cesarean section for the following reasons:

medicinal product penetrates the placenta more slowly than with its intravenous administration, therefore the risk of undesirable consequences for the fetus is much less;
the risk of complications for the respiratory and cardiovascular systems is minimized, since the device removes carbon dioxide from the body and supplies the lungs with oxygen;
anesthetics are supplied in more precise quantities, and the dosage of the drug can be changed at any time;
the doctor monitors the level of oxygen saturation and the volume of ventilation received by the lungs;
the contents of the stomach cannot penetrate into the lungs.

So when asked which anesthesia is better for a caesarean section - intravenous or endotracheal, doctors most often answer unequivocally: the latter option is preferable. Still, this type of general anesthesia has its drawbacks.

Minuses

The bodies of the mother and the baby may react differently to medications administered through general endotracheal anesthesia. As a result, the consequences of such an operation are sometimes not only unpleasant, but also dangerous to health. Among them:

nausea;
sore throat, muscles;
shiver;
dizziness to the point of fainting;
weak consciousness;
injuries to the tongue, lips, teeth, throat;
lung infections;
allergy;
anaphylactic shock;
brain damage in both the mother and the baby;
as well as damage nerve processes both have.

Even doctors cannot always predict the negative consequences of endotracheal general anesthesia, especially in conditions of delivery, when they are responsible for the life of the mother and child. Therefore in Lately Regional types of anesthesia for caesarean section are used, which have a less harmful effect on the fetus: spinal, epidural and spino-epidural.

Through the pages of history. In ancient times, during childbirth, electric rays were used as a kind of anesthesia.

Spinal anesthesia

Local (regional) spinal anesthesia for caesarean section ensures blocking of all types of sensitivity. In some sources it may be called spinal. It consists in the fact that the drug is injected through a puncture between the vertebrae into the cerebrospinal fluid. In this case, the needle is inserted much deeper than with epidural anesthesia.

The second difference of this technique is the position of the woman in labor when the anesthetic is administered. With an epidural, she sits, whereas here she will be asked to lie in the fetal position, with her legs tucked under her stomach as much as possible.

Indications

During a caesarean section it is performed spinal anesthesia in the following cases:

an emergency situation, and general anesthesia is contraindicated;
performed epidural anesthesia at the beginning, which must be completed by cesarean section;
gestosis;
heart disease;
arterial hypertension;
diabetes;
kidney problems.

This is a gentle type of anesthesia that doctors resort to if a woman in labor exhibits any serious problems with health. However, spinal anesthesia has a number of contraindications that must be kept in mind.

Contraindications

Available the following contraindications for spinal anesthesia during cesarean section:

the patient’s refusal of this type of anesthesia;
absence necessary equipment or a qualified specialist;
large blood loss;
disorders associated with the circulatory system;
any infections, inflammation, sepsis, ;
allergy to the administered drug;
heart problems;
high intracranial pressure;
diseases of the central nervous system;
use of heparin, warfarin or other anticoagulants immediately before surgery.

If at least one contraindication from this list, mother and child can expect the most serious complications after spinal anesthesia used during caesarean section. That is why, if surgery is performed, a woman should discuss all her health problems with her attending physician and decide whether it is suitable for her. this type anesthesia or not. It has its advantages and disadvantages.

pros

Most frequently asked question questions asked by women in labor preparing for a caesarean section - which is better: spinal or epidural anesthesia? The choice will largely depend on individual characteristics female body, the course of pregnancy and many other factors. Advantages of spinal anesthesia:

excellent pain relief without the errors that occur with epidural anesthesia;
excellent relaxation of the muscular system;
speed of action: only 5-7 minutes;
minimal exposure to drugs on the fetus: with epidural anesthesia, the volume of the administered substance is much larger;
the ability to remain conscious throughout childbirth;
due to lower blood pressure, doctors can control blood loss;
passes faster and much easier than after general anesthesia;
using a thinner needle than with epidural anesthesia, so that pain at the puncture site is subsequently eliminated;
no risk of spinal cord damage;
lower price.

When it comes to the question of which anesthesia to choose (epidural or spinal) for a caesarean section, price does not at all determine quality. Here it is lower only because the volume of the administered drug is much less than that used for epidural anesthesia. And, of course, no type of anesthesia is without its drawbacks.

Minuses

In rare cases, the effects of spinal anesthesia during a caesarean section can be as dangerous as those under general anesthesia. So the woman in labor should know in advance about all the disadvantages of this type of anesthesia, which include:

High professionalism of the anesthesiologist is required;
complications include infection, meningitis, toxic poisoning, convulsions, respiratory arrest, spinal cord damage, death, severe headaches or back pain symptoms that may last for several months after surgery;
due to an incorrect puncture, anesthesia may not work at all;
the anesthetic is weak, but can still have an effect on the child;
limited (no more than 2 hours) duration of action of the anesthetic drug:
a sharp drop in blood pressure in a woman in labor, which is accompanied by attacks of nausea and dizziness.

So, if you are going to have a caesarean section, it is worth weighing the pros and cons of spinal anesthesia before using this method of anesthesia. Despite the low cost compared to epidural anesthesia, sometimes it makes sense to use the latter option.

Significant date. On October 16, back in 1846, Thomas Morton (American dentist) performed an operation under anesthesia. This date is now considered Anesthesiologist's Day all over the world.

Epidural anesthesia

Recently, epidural anesthesia is increasingly used for planned caesarean sections, which does not require the same precision and professionalism from the anesthesiologist as with spinal anesthesia. These two types of anesthesia are very similar, but you need to understand the differences in order to make the right choice.

Differences from spinal anesthesia

Can't decide which type of anesthesia to prefer? In this case, find out in advance how epidural anesthesia is performed and how it differs from spinal anesthesia. After all, each of them will have its own consequences for your body and for the health of the baby.

It begins to act 20, not 5 minutes after administration of the medicine.
The anesthetic is injected into the epidural space of the spine rather than into the cerebrospinal fluid.
The needle is much thicker.
It is inserted between the spinal canal and the dura mater of the brain, and not between the vertebrae.
The needle insertion is much more superficial than with spinal anesthesia.
A catheter is inserted and remains in the spine throughout the operation. During spinal anesthesia there is no such tube.
More expensive, since the volume of the drug that is introduced into the body is much larger.

Concerning side effects problems that a woman may experience right on the operating table, there can be no clear answer. Different women in labor may experience different sensations under epidural anesthesia and spinal anesthesia. Some people feel only a slight tingling sensation when the needle is inserted, while others experience convulsions if a nerve is accidentally touched. So here it all depends on the level of pain threshold and individual characteristics.

Indications

if at the beginning natural birth it had already been performed, but surgical intervention was urgently required;
serious illnesses in a woman in labor: gestosis, high pressure, kidney or liver problems, severe myopia, ;
premature pregnancy;
contraindications for general anesthesia;
excessive labor activity, pathologies of the cervix;
the desire of the woman in labor.

If a problem arises, which is better: general anesthesia or epidural anesthesia, the doctor looks first of all at the health status of the expectant mother. The latter option of anesthesia is more gentle and has a minimum negative influence for the fruit. It is for this reason that at the present time preference is given to regional methods of pain relief.

Contraindications

When preparing for a caesarean section, you must take into account all the contraindications to epidural anesthesia, of which there are many. Otherwise, serious complications and irreversible consequences may occur. This method cannot be used in the following cases:

presence of problems with blood clotting;
bleeding;
increased intracranial pressure;
tattooing on the back, affecting the puncture site;
infections, inflammations, tumors, wounds and any other lesions skin at the puncture site;
allergy to a drug;
epilepsy;
elevated temperature;
arrhythmia;
intestinal obstruction;
heart disease;
diseases of the central nervous system;
traumatic shock;
cardiovascular, posthemorrhagic collapse;
diseases of the spine and spinal cord;

During the day, the Clexane injection used for the treatment and prevention of thrombosis is often contraindicated for women in labor. If for some reason these contraindications were not taken into account, consequences of epidural anesthesia for caesarean section may occur, which pose a danger to the health of the mother and child. If the prenatal examination was thorough, this type of anesthesia does not contain any obvious pitfalls: it has many advantages.

Advantages

Here are the benefits of epidural anesthesia for caesarean section:

complete pain relief;
not like that strong impact on the fetus, as with general anesthesia;
the woman has the opportunity to see her baby immediately after the operation;
Epidural anesthesia for caesarean section lowers blood pressure so that the surgeon can control blood loss throughout the operation;
the postoperative period is much easier to tolerate;
the catheter allows you to control the dosage of the anesthetic - this is the main advantage of epidural anesthesia, which spinal anesthesia does not have.

Like other types of anesthesia for caesarean section, epidural has its disadvantages, which are expressed primarily in a huge number consequences for the health of mother and child after surgery.

Flaws

The disadvantages of epidural anesthesia, which is used for caesarean section, include:

erroneous administration of the drug into a vessel can provoke convulsions, a sharp decrease in pressure, which leads to death or serious damage brain;
a decrease in blood pressure can cause a woman severe dizziness and an attack of nausea right during childbirth;
the drug introduced into the body will still have some effect (and a negative one) on the fetus;
If the caesarean section is not completed within 2 hours due to unforeseen complications, the epidural anesthesia will have to be extended.

The most serious disadvantage of this type of anesthesia used during cesarean section is the consequences after epidural anesthesia, which are sometimes too dangerous and irreversible. It is almost impossible to predict them.

Consequences

As a result of non-compliance with contraindications or the individual characteristics of the mother’s body, complications of epidural anesthesia after cesarean section sometimes occur. They can affect the health, even the life, of both mother and child.

Complications for the mother during childbirth:

damage to the dura mater;
decreased heart rate;
nausea, vomiting;
chills;
spinal cord injury;
back pain;
toxic reaction to the drug.

Postpartum consequences for women:

severe head and back pain;
problems with lactation;
loss of sensation in the lower extremities;
CNS disorders.

Complications for the child:

decrease in heart rate;
breathing problems, motor skills;
disorientation;
difficulty sucking;

If spouses who are about to become parents are faced with the problem of which anesthesia is better for a caesarean section, it should only be resolved together with their attending physician. After a thorough and circumstantial examination, he can draw conclusions and advise the most suitable option. Otherwise, the consequences of epidural anesthesia will not be long in coming. In rare cases, doctors decide to do spino-epidural (epidural-spinal) anesthesia.

Interesting fact. One chance in 200 thousand is the probability of a woman in labor dying from anesthesia.

Spinoepidural anesthesia

Combined epidural-spinal anesthesia is a method that combines both types of anesthesia. Spinal anesthesia is performed, but with catheterization. Allows you to use the advantages of both and neutralize their disadvantages. It became widespread specifically during surgical delivery not so long ago, but has proven itself simply excellent. An increasing number of doctors are leaning towards this method of pain relief.

Knowing in advance that you will have to give birth through surgery, find out in more detail what kind of anesthesia is used for a caesarean section in the maternity hospital where you are going to undergo surgery. This will allow you to fully prepare for it, find out all the pitfalls, and resolve controversial and doubtful issues with your doctor. The calmer the mother is before a significant event, the smoother and better it will go.

Caesarean section is delivery surgically, in which the child is removed through an incision in the mother's uterus. There are planned caesarean sections and emergency ones. I survived two such operations, as a result of which I have two wonderful daughters. I had a planned caesarean section due to myopia high degree. If myopia entails changes in the retina of the eye, then cesarean section is the only way of delivery. 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

I was admitted to the hospital a week before giving birth. Here they put me on IVs, gave me vitamins, and monitored my tests. In general, they prepared for the operation. I gave birth in rural areas, so the choice of anesthesia was small, or rather there was none at all. The day before the operation, the anesthesiologist called me for a conversation and warned me that in this hospital they only provide general anesthesia. Roughly speaking, they will put me to sleep, and I will wake up in the ward, becoming a mommy. Before the operation, I took control tests and passed 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 spread out dissected frog. It was very scary. I was afraid of not falling asleep and feeling everything, afraid of not waking up at all. The fear of the unknown was scary! Before we started, we were given oxygen to breathe using a mask, and then anesthesia was injected into a vein through a 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 there’s an incomprehensible white sticky mass pressing around me. I hear some kind of growing rumble and really want to get out of here, but I can’t.

And then I opened my eyes. I regained consciousness poorly. felt severe weakness, felt dizzy, blood pressure dropped to 70/40. I was very thirsty. I didn’t feel any pain because I was injected with painkillers. And I also wanted to know what was wrong with the child, how was he. I completely recovered from anesthesia only in the evening.

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

My second birth under epidural anesthesia

My second surgery occurred seven years later. This time I was advised local anesthesia, since it is more gentle. The beginning was the same as the first time: tests, enema, operating room. They gave an injection to the lower part of the spine. It does not hurt. They hung a curtain in front of me so that I could not see the doctors’ actions. I felt my lower body go numb. I didn’t feel how they cut me. Only when they took the baby out did I feel like something was being pulled out of me, but there was no pain. And then I heard my baby scream. This is such happiness! All mothers will understand me. This is an unforgettable moment. I cried with great joy. They showed me their daughter right away. The whole operation took 40 minutes. At the end, they gave me a sedative injection and took me to the ward. I immediately called all my relatives and told the good news. After the operation I was very chilled, but it was tolerable. Ice was applied to the seam and an anesthetic was injected. I began to feel the lower part of my body after three hours. By evening they lifted me out of bed and I tried to leave. On the second day they gave me the baby, and I fed it without any problems breast milk. The stitch hurt for five days. Longer than the first time. But a week later I forgot about him.

To summarize briefly, if you are given a choice of anesthesia, then choose only spinal anesthesia. It is much easier to tolerate; you are conscious throughout the operation. You have the opportunity to see the child and be aware of everything that is happening. 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 early as possible. Even if it hurts, it’s hard, your head is spinning, but you have to overcome it, force yourself. Otherwise, the seam will heal slowly, and adhesions will also form. Do you need this? As soon as you come to your senses, try not to lie on your back all the time, but turn first to one side, then to the other. And after six hours, rise slowly. 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 around a little, lie down, relax. I know from myself that I really want to lie down, but I have to overcome myself. It is very important to separate in the first days. Thanks to this, you will be able to walk without problems on the third day after surgery. When you breastfeed, you will feel pain in the uterine area and increased bleeding. This is fine! When a baby sucks at the breast, the uterus contracts. Be sure to wear a bandage. With its help, there will be no pressure on the seam, and it will heal faster. After discharge, treat the seam with brilliant green for five days. I took a bath on the second day after the operation. After six months you can start exercising.

Restoring shape after a cesarean section is slower because 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 my vision, and I no longer even remember the operations. The seam has long since healed and turned pale. Under underwear it is absolutely invisible. Giving birth through surgery is not scary. The main thing is to think about your baby. Health to you and your children!