Advertisement

Regional anaesthesia for operative delivery

  • Ian Russell

Abstract

In the first proceedings of the symposium on Epidural Analgesia in Obstetrics1 caesarean section under regional anaesthesia is scarcely mentioned: Crawford2 and Tunstall3 specifically state they do not use an epidural catheter inserted for labour for subsequent caesarean section and Moir, 4 describing 1800 epidurals over a 4–5 year period, only performed 30 caesarean sections under epidural anaesthesia. It would appear that the vast majority of caesarean sections were conducted with general anaesthesia. Steens was particularly scathing about “Paralyse and Puff” anaesthetists when he described “the extremely meagre repertoire” of anaesthetists who could not “perform a lumbar puncture, still less an epidural, with much confidence”. How times change! Now regional anaesthesia accounts for 78% of caesarean section anaesthetics (Shibli KU, Russell IF. A survey of anaesthetic techniques used for caesarean section in the UK in 1997. International Journal of Obstetric Anesthesia 2000; in press) a major increase since 1982.6

Keywords

Spinal Anaesthesia Epidural Analgesia Regional Anaesthesia Epidural Space Elective Caesarean Section 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Doughty A. (Ed) Proceedings of the Symposium on epidural Analgesia. London: HK Lewis, 1972Google Scholar
  2. 2.
    Crawford JS. Observations on one thousand epidural blocks given in labour. In: Doughty A. (ed) Proceedings of the Symposium on epidural Analgesia. London: HK Lewis, 83–8, 1972Google Scholar
  3. 3.
    Tunstall ME. Complications of epidural analgesia. In: Doughty A. (ed) Proceedings of the Symposium on epidural Analgesia. London: HK Lewis, 64–6, 1972Google Scholar
  4. 4.
    Moir DD. Indications for epidural analgesia with special reference to the management of pre-eclampsia. In: Doughty A. (ed) Proceedings of the Symposium on epidural Analgesia. London: HK Lewis, 73–9, 1972Google Scholar
  5. 5.
    Steen TR. Why are epidurals not more widely practised? In: Doughty A. (ed) Proceedings of the Symposium on epidural Analgesia. London: HK Lewis, 101–2, 1972Google Scholar
  6. 6.
    Brown GW, Russell IF. A survey of anaesthesia for caesarean section. International Journal of Anesthesia 1995; 4: 214–8.CrossRefGoogle Scholar
  7. 7.
    Hirabayashi Y, Shimizu R, Saitoh K, Fukuda H. Reevaluation of physiologic curvature of the thoracolumbar spinal column in the supine position. Anesthesiology 1994; 81: 266–7PubMedCrossRefGoogle Scholar
  8. 8.
    Hirabayashi Y, Shimizu R, Saitoh K, Fukuda H, Furuse M. Anatomical configuration of the spinal column in the supine position I: A study using magnetic resonance imaging. Br J Anaesth 1995; 75: 3–5PubMedCrossRefGoogle Scholar
  9. 9.
    Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Furuse M. Anatomical configuration of the spinal column in the supine position II Comparison of pregnant and non pregnant women. Br J Anaesth 1995; 75: 6–8PubMedCrossRefGoogle Scholar
  10. 10.
    Hogan QH, Prost R, Kulier A, Taylor ML, Lui S, Leighton M. Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure. Anesthesology 1996; 84: 1341–9CrossRefGoogle Scholar
  11. 11.
    Hirabayashi Y, Saitoh K, Fukuda H, Igarashi T, Shimizu R, Seo N. Soft tissue anatomy within the vertebral canal in pregnant women. Br J Anaesth 1996; 77: 153–6CrossRefGoogle Scholar
  12. 12.
    Hirabayashi Y, Shimizu R, Fukuda H, Saitoh K, Igarashi T. Effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, as determined by magnetic resonance imaging. Br J Anaesth 1997; 78: 317–9CrossRefGoogle Scholar
  13. 13.
    Russell I F. Spinal anaesthesia for caesarean section: the use of 0.5% bupivacaine. Br J Anaesth 1983; 55: 309–14PubMedCrossRefGoogle Scholar
  14. 14.
    Russell IF. Posture and isobaric subarachnoid anaesthesia: the influence on spread of spinal anaesthesia with “isobaric” 0.5% bupivacaine plain. Anaesthesia 1984; 39: 865–7PubMedCrossRefGoogle Scholar
  15. 15.
    Covino BG, Scott DB. Handbook of epidural anaesthesia and analgesia, London: Grune & Stratton, 125 1985Google Scholar
  16. 16.
    Moir DD. Obstetric anaesthesia and analgesia. 2nd Ed. London: Baillière Tindall, 215. (1980)Google Scholar
  17. 17.
    Datta S, Alper MH. Anesthesia for cesarean section. Anesthesiology 1980; 53: 142–60PubMedCrossRefGoogle Scholar
  18. 18.
    Brull SJ, Greene NM. Time-courses of zones of differential sensory blockade during spinal anesthesia with hyperbaric tetracaine or bupivacaine. Anesth Analg 1989; 69: 342–7PubMedCrossRefGoogle Scholar
  19. 19.
    Brull SJ, Greene NM. Zones of differential sensory block during extradural anaesthesia. Br J Anaesth 1991; 66: 651–5PubMedCrossRefGoogle Scholar
  20. 20.
    Russell IF. Levels of anaesthesia associated with intra-operative pain at caesarean section under spinal or epidural block. International Journal of Obstetric Anesthesia 1995; 4: 71–7PubMedCrossRefGoogle Scholar
  21. 21.
    James KS, Stott SM, McGrady EM, Pearsall FJ, Frame WT, Russell D. Spinal anaesthesia for caesarean section: effect of Sprotte needle orientation. Br J Anaesth 1996; 77: 150–2PubMedCrossRefGoogle Scholar
  22. 22.
    Arendt-Neilsen L, Oberg B, Bjerring P. Quantitative assessment of extradural bupivacaine analgesia. Br J Anaesth 1990; 65: 633–8CrossRefGoogle Scholar
  23. 23.
    Arendt-Neilsen L, Anker-Moller E, Bjerring P, Spansberg N. Onset phase of spinal bupivacaine analgesia assessed quantitatively by laser stimulation. Br J Anaesth 1990; 65: 636–42Google Scholar
  24. 24.
    Pedersen H, Santos A, Steinberg E, Schapiro H, Harmon T, Finster M. Incidence of visceral pain during cesarean section: the effect of varying doses of spinal bupivacaine. Anesth Analg 1989; 69: 46–9PubMedCrossRefGoogle Scholar
  25. 25.
    Pan P, Lin Z-F, Lim J, Tung M-C, Wei T-T. The optimal does of hyperbaric tetracaine spinal anaesthesia for caesarean section. Acta Anaesth Sinica 1989; 27: 349–52Google Scholar
  26. 26.
    Alahuhta S, Kangas-Saarela T, Hollmén A I, Edström HH. Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine. Acta Anaesthesiol Scand 1990; 34: 95–8PubMedCrossRefGoogle Scholar
  27. 27.
    Hirabayashi Y, Saitoh K, Fukuda H, Shimizu R. Visceral pain during caesarean section: effect of varying dose of spinal amethocaine. Br J Anaesth 1995; 75: 266–8PubMedCrossRefGoogle Scholar
  28. 28.
    Bourne TM, deMelo BA, Bastianpillai BA, May AE. A survey of how British obstetric anaesthetist test regional anaesthesia before caesarean section. Anaesthesia 1997; 52: 901–3PubMedCrossRefGoogle Scholar
  29. 29.
    Laishley RS, Morgan BM. A single dose epidural technique for caesarean section: A comparison between 0.5% bupivacaine plain and 0.5% bupivacaine with adrenaline. Anaesthesia 1988; 43: 100–3PubMedCrossRefGoogle Scholar
  30. 30.
    Norton AC, Davis AG, Spicer RJ. Lignocaine 2% with adrenaline for epidural caesarean section: A comparison with 0.5% bupivacaine. Anaesthesia 1988; 43: 844–9PubMedCrossRefGoogle Scholar
  31. 31.
    Howell P, Davies W, Wrigley M, Tan P, Morgan B. Comparison of four local extradural anaesthetic solutions for elective caesarean section. Br J Anaesth 1990; 65: 648–53PubMedCrossRefGoogle Scholar
  32. 32.
    Noble DW, Morrison LM, Brockway MS, McClure JH. Adrenaline, fentanyl or adrenaline and fentanyl as adjuncts to bupivacaine for extradural anaesthesia in elective caesarean section. Br J Anaesth 1991; 66: 645–50PubMedCrossRefGoogle Scholar
  33. 33.
    Fernando R, Jones HM. Comparison of plain and alkalinised local anaesthetic mixtures of lignocaine and bupivacaine for elective extradural caesarean section. Br J Anaesth 1991; 67: 699–703PubMedCrossRefGoogle Scholar
  34. 34.
    Clarke V, McGrady E, Sugden C et al. Speed of onset of sensory block for elective extradural caesarean section: choice of agent and temperature of injectate. Br J Anaesth 1994; 72: 221–3CrossRefGoogle Scholar
  35. 35.
    Price ML, Reynolds F, Morgan BM. Extending epidural blockade for emergency caesarean section. Evaluation of 2% lignocaine with adrenaline. International Journal of Obstetric Anesthesia 1991; 1: 13–8PubMedCrossRefGoogle Scholar
  36. 36.
    Gaiser RR, Cheek TG, Gutsche BB. Epidural lidocaine versus 2-chloroprocaine for fetal distress requiring urgent cesarean section. International Journal of Obstetric Anesthesia 1994; 3: 208–10PubMedCrossRefGoogle Scholar
  37. 37.
    Gaiser RR, Cheek TG, Adams HK, Gutsche BB. Epidural lidocaine for cesarean delivery of the distressed fetus. International Journal of Obstetric Anesthesia 1998; 7: 27–31PubMedCrossRefGoogle Scholar
  38. 38.
    Helbo-Hansen HS, Bang U, Lindholm P, Klitgaard NA. Neonatal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section. International Journal of Obstetric Anesthesia 1993; 2: 27–33PubMedCrossRefGoogle Scholar
  39. 39.
    Paech MJ, Westmore MD, Speirs HM. A double-blind comparison of epidural bupivacaine and bupivacaine-fentanyl for caesarean section. Anaesth Intens Care 1990; 18: 22–30Google Scholar
  40. 40.
    Noble OW, Morrison LM, Brockway MS, McClure JH. Respiratory depression after extradural fentanyl. Br J Anaesth 1994; 72: 251PubMedCrossRefGoogle Scholar
  41. 41.
    Dutton DA, Moir DD, Howie HB et al. Choice of local anaesthetic drug for extradural caesarean section: Comparison of 0.5% and 0.75% bupivacaine and 1.5% etidocaine. Br J Anaesth 1984; 56: 1361–8PubMedCrossRefGoogle Scholar
  42. 42.
    Santos A, Pedersen H, Finster M, Edstrom H. Hyperbaric bupivacaine for spinal anesthesia in cesarean section. Anesth Analg 1984; 63: 100–13.Google Scholar
  43. 43.
    Pedersen H, Santos AC, Steinberg Steinberg ES, Schapiro HM, Harmon TW, Finster M. Incidence of visceral pain during Cesarean section: The effect of varying doses of spinal bupivacaine. Anesth Analg 1989; 69: 46–9Google Scholar
  44. 44.
    Inglis A, Daniel M, McGrady E. Maternal position during induction of spinal anaesthesia for caesarean section: A comparison of right lateral and sitting positions. Anaesthesia 1995; 50: 363–5Google Scholar
  45. 45.
    Hopkinson JM, Samaan AK, Russell IF, Birks RJS, Patrick MR. A comparative multicentre trial of spinal needles for caesarean section. Anaesthesia 1997; 52: 1005–11PubMedCrossRefGoogle Scholar
  46. 46.
    Masse E, Drolet P, Girard M. Direction of injection does not affect the spread of spinal bupivacaine in parturients. Can J Anaesth 1997; 44: 816–9PubMedCrossRefGoogle Scholar
  47. 47.
    Swart M, Sewell J, Thomas D. Intrathecal morphine for caesarean section: an assessment of pain relief, satisfaction and side effects. Anaesthesia 1997; 52: 373–5PubMedCrossRefGoogle Scholar
  48. 48.
    Kelly MC, Carabine UA, Mirakhur RK. Intrathecal diamorphine for analgesia after caesarean section. A dose finding study and assessment of side-effects. Anaesthesia 1998; 53: 231–7PubMedCrossRefGoogle Scholar
  49. 49.
    Shende D, Cooper GM, Bowden MI. The influence of intradural fentanyl on the characteristics of subarachnoid block for caesarean section. Anaesthesia 1998; 53: 706–10PubMedCrossRefGoogle Scholar
  50. 50.
    Russell IF, Holmqvist ELO. Subarachnoid analgesia for caesarean section. A double-blind comparison of plain and hyperbaric 0.5% bupivacaine. Br J Anaesth 1987; 59: 347–53PubMedCrossRefGoogle Scholar
  51. 51.
    Graham D, Russell IF. A double-blind assessment of the analgesic sparing effect of intrathecal diamorphine (0.3 mg) with sinal anaesthesia for elective caesarean section. International Journal of Obstetric Anesthesia 1997; 6: 224–30PubMedCrossRefGoogle Scholar
  52. 52.
    Husaini SW, Russell IF. Volume preload: lack of effect in the prevention of spinal-induced hypotension at caesarean section. International Journal of Obstetric Anesthesia 1998; 7: 76–81PubMedCrossRefGoogle Scholar
  53. 53.
    Alahuhta S, Karinen J, Lumme R et al. Uteroplacental haemodynamics during spinal anaesthesia for caesarean section with two types of uterine displacement. International Journal of Obstetric Anaesthesia 1994; 3: 187–92CrossRefGoogle Scholar
  54. 54.
    Marx GF, Luykx WM, Cohen S. Foetal-neonatal status following caesarean section for foetal distress. Br J Anaesth 1984; 56: 1009–13CrossRefGoogle Scholar
  55. 55.
    Sghirlanzoni S, Attanasio A, Della Grazia L et al. Spinal anaesthesia for elective caesarean section: comparison of three different anaesthetic solutions. 14’x’ Annual European Society of Regional Anaesthesia Congress, Prague, 1995. The International Monitor 1995; September: 89Google Scholar
  56. 56.
    Sibilla C, Albertazzi P, Zatelli R, Martinello R. Perioperative analgesia for caesarean section: comparison of intrathecal morhpine and fentanyl alone or in combination. International Journal of Obstetric Anesthesia 1997; 6: 43–8PubMedCrossRefGoogle Scholar
  57. 57.
    Moore A, Bullingham R, McQuay H, Allen M, Baldwin D, Cole A. Spinal fluid kinetics of morphine and heroin. Clin Pharmacol Ther 1984; 35: 40–5PubMedCrossRefGoogle Scholar
  58. 58.
    Husaini SW, Russell IF. Intrathecal diamorphine compared with morphine for postoperative analgesia after caesarean section under spinal anaesthesia. Br J Anaesth 1998; 81: 135–9PubMedCrossRefGoogle Scholar
  59. 59.
    Robson SC. Controversies, Opposer to the motion: “The danger of convulsions precludes the use of regional block for caesarean section in fulminating preeclampsia”. International Journal of Obstetric Anesthesia 1993; 2: 104–5PubMedCrossRefGoogle Scholar
  60. 60.
    Hood DD, Boese PA. Epidural and spinal anaesthesia for elective cesarean section in severely preeclamptic parturients. Reg Anesth 1992; 17: 15, 35.Google Scholar
  61. 61.
    Wallace DH, Leveno KJ, Cunningham FG, Giescke AH, Shearer VE, Sidawi JE. Randomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe preeclampsia. Obstet Gynecol 1995; 86: 193–9PubMedCrossRefGoogle Scholar
  62. 62.
    Karinen J, Rasanen J, Alahuhta S, toupilla R, Jouppilla P. Maternal and uteroplacental haemodynamic state in preeclamptic patients during spinal anaesthesia for caesarean section. Br J Anaesth 1996; 76: 616–620PubMedCrossRefGoogle Scholar
  63. 63.
    Watson EG, Clark VA, Sharwood-Smith G. Spinal vs epidural anaesthesia for caesarean section in pregnancy-induced hypertension. International Journal of Obstetric Anesthesia 1999; 8: 85–9CrossRefGoogle Scholar
  64. 64.
    Howell P. Spinal anaesthesia in severe preeclampsia: time for a reappraisal, or time for caution? International Journal of Obstetric Anesthesia 1998; 7: 217–9PubMedCrossRefGoogle Scholar
  65. 65.
    Crawford JS. Principals and practice of obstetric anaesthesia, 5th Edition, 261, 351, 362. Oxford: Blackwell Scientific Publications, 1984Google Scholar
  66. 66.
    Wildsmith JAW, McClure JH. Anticoagulant drugs and central nerve blockade. Anaesthesia 1991; 46: 613–4PubMedCrossRefGoogle Scholar
  67. 67.
    Blasi A, Gomar C, Fernandez C, Nalda MA. Indication de la anestesia espinal para la cesarea en la coagulopatia por sindrome de HELLP. Rev Esp Anestesiol Reanim 1997; 44: 79–82PubMedGoogle Scholar
  68. 68.
    Mets B, Broccoli E, Brown AR. Is spinal anesthesia after failed epidural anesthesia contraindicated for cesarean section. Anesth Analg 1993; 77: 629–31PubMedCrossRefGoogle Scholar
  69. 69.
    Gupta A, Enlund G, Bengtsson M, Sjöberg F. Spinal anaesthesia for caesarean section following epidural analgesia in labour: a relative contraindication. International Journal of Obstetric Anesthesia 1994; 3: 153–6PubMedCrossRefGoogle Scholar
  70. 70.
    Rigler ML, Drasner K, Krejcie TC et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg 1991; 72: 275–81PubMedCrossRefGoogle Scholar
  71. 71.
    de Jong RH. Last round for a “heavyweight”? Anesth Analg 1993; 78: 3–4.Google Scholar
  72. 72.
    Bevacqua BK, Slucky AV & Cleary WF. Spinal catheter size and hyperbaric lidocaine dosing: A retrospective review. Reg Anesth 1994; 19: 136–41Google Scholar
  73. 73.
    Russell IF. Effect of posture during the induction of subarachoid analgesia for caesarean section: Right v Left lateral. Br J Anaesth 1987; 59: 342–6PubMedCrossRefGoogle Scholar
  74. 74.
    Kestin IG, Madden AP, Mulvein JT, Goodman NW. Comparison of incremental spinal anaesthesia using a 32 gauge catheter with extradural anaesthesia for elective caesarean section. Br J Anaesth 1991; 66: 232–6PubMedCrossRefGoogle Scholar
  75. 75.
    Tunstall ME. Incremental spinal anaesthesia and caesarean section - relevance to the test dose for extradural analgesia. Br J Anaesth 1991; 67: 227–8PubMedCrossRefGoogle Scholar
  76. 76.
    Tuohy EB. Continuous spinal anesthesia: its usefulness and technic involved. Anesthesiology 1944; 5: 142–8CrossRefGoogle Scholar
  77. 77.
    Tuohy EB. The use of continuous spinal anesthesia utilizing the ureteral catheter technique. JAMA 1945; 128: 262–4CrossRefGoogle Scholar
  78. 78.
    Sprague DH. Effects of position and uterine displacement on spinal anesthesia for cesarean section. Anesthesiology 1976; 44: 164–6PubMedCrossRefGoogle Scholar
  79. 79.
    Milligan KR, Carp H. Continuous spinal anaesthesia for caesarean section in the morbidly obese. International Journal of Obstetric Anesthesia 1992; 1: 111–3PubMedCrossRefGoogle Scholar
  80. 80.
    Moran DH, Johnson MD. Continuous spinal anesthesia with combined hyperbaric and isobaric bupivacaine in a patient with scoliosis. Anesth Analg 1990; 70: 445–7PubMedCrossRefGoogle Scholar
  81. 81.
    Nuyten F, Gielen M. Spinal catheter anaesthesia for caesarean section in a patient with spina bifida. Anaesthesia 1990; 45: 846–7PubMedCrossRefGoogle Scholar
  82. 82.
    Kardash K, King B, Datta S. Spinal anaesthesia for caesarean section after Harrington instrumentation. Can J Anaesth 1993; 40: 667–9PubMedCrossRefGoogle Scholar
  83. 83.
    Tourney PJ, Russell IF. A technique to facilitate 32 gauge subarachnoid catheter placement. Reg Anesth 1993; 18: 200–1Google Scholar
  84. 84.
    Why mothers die. Report on confidential enquiries into maternal deaths in the United Kingdom 1994–1996. Department of Health, Welsh Office, Scottish Office Department of Health, Department of Health and Social Services Northern Ireland. The Stationery Office, 92–102, 1998Google Scholar
  85. 85.
    Wildsmith JAW. Problems with combined spinal epidural anesthesia (Editorial). Reg Anesth 1998; 23: 388–9CrossRefGoogle Scholar
  86. 86.
    Zarzur E. The posterior epidural space depth. Reg Anesth 1998; 23: 108–9CrossRefGoogle Scholar
  87. 87.
    Randalls B, Broadway JW, Browne DA, Morgan BM. Comparison of four subarachnoid solutions in a needle-through-needle technique for elective caesarean section. Br J Anaesth 1991; 66: 314–8PubMedCrossRefGoogle Scholar
  88. 88.
    Rawal N, Schollin J, Wesrtröm G. Epidural versus combined spinal epidural block for caesarean section. Acta Anaesthiol Scand 1988; 32: 61–6CrossRefGoogle Scholar
  89. 89.
    Westerbrook JL, Donald F, Carrie LES. An evaluation of a combined spinal/epidural needle set utilising a 26 gauge, pencil point needle for caesarean section. Anaesthesia 1992; 47: 990–2CrossRefGoogle Scholar
  90. 90.
    Davies SJ, Paech MJ, Welch H, Evans SF, Pavy TJG. Maternal experience during epidural or combined spinal-epidural for cesarean section: a prospective randomised trial. Anesth Analg 1997; 85: 607–13PubMedGoogle Scholar
  91. 91.
    Thorén T, Holmström B, Rawal N; Schollin J, Lindeberg S, Skeppner G. Sequential combined. spinal epidural block versus spinal block for cesarean section: Effects on maternal hypotension and neurobehavioural function of the newborn. Anesth Analg 1994; 78: 1087–92PubMedGoogle Scholar
  92. 92.
    Patel M, Samsoon G, Swami A, Morgan B. Posture and the spread of hyperbaric bupivacaine in parturients using the combined spinal epidural technique. Can J Anaesth 1993; 40: 943–6PubMedCrossRefGoogle Scholar
  93. 93.
    Budd A, Russell IF. The influence of an epidural fluid challenge on spinal anaesthesia. Proceedings of the Obstetric Anaesthetists Association, Spring Meeting, Hull 1987, 20.Google Scholar
  94. 94.
    Blumgart CH, Ryall D, Dennison B, Thompson-Hill LM. Mechanism of extension of spinal anaesthesia by extradural injection of local anaesthetic. Br J Anaesth 1992; 69: 457–60PubMedCrossRefGoogle Scholar
  95. 95.
    Stienstra R, Dahan A, Alhadi BZR, van Kleef JW, Burm AGL. Mechanism of action of an epidural top up in combined spinal epidural anesthesia. Anesth Analg 1996; 83: 382–6PubMedGoogle Scholar
  96. 96.
    Mardirosoff C, Dumont L, Lemédioni P, Pauwels P, Massaut J. Sensory block extension during combined spinal and epidural. Reg Anesth Pain Med 1998; 23: 92–5PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2000

Authors and Affiliations

  • Ian Russell

There are no affiliations available

Personalised recommendations