Regional anaesthesia for caesarean section and what to do when it fails

Almost 90% of caesarean sections in the UK are performed under regional anaesthesia. Preoperative assessment should include airway assessment, and informed consent should be documented in detail. Antacid prophylaxis and an appropriate fasting period are mandatory. Both maternal and fetal monitoring should be undertaken during induction of anaesthesia. Maternal hypotension and vena-caval compression are minimized by careful maternal positioning and use of vasopressors. The sensory block should be tested to light touch and the level documented prior to surgery. Pain during surgery is a frequent cause of litigation. If possible surgery should be halted. Management options include nitrous oxide, intravenous opioids or ketamine, epidural 'top-up' and local infiltration. Most importantly general anaesthesia must always be offered and this documented. All women having a caesarean should be followed up within 24 hours by the anaesthetic team.