Regional versus general anaesthesia for caesarean section
RHL practical aspects by Bamigboye AA
FIRST CONTACT (PRIMARY CARE) LEVEL
- Caesarean section operations are normally not performed at this level. Pregnant women at high risk for elective caesarean section (e.g. women who have previously delivered by caesarean sections, women with a malpresented fetus, and HIV-positive women) should be referred to a secondary level facility for their antenatal care.
- The type of anaesthesia does not have any significance at primary level.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
At the referral hospital, women who are to undergo elective caesarean section should be fully informed about the steps in the procedure and its possible adverse effects.
In general, as part of regular counselling, women should be told that serious side-effects of general anaesthesia are uncommon. General anaesthesia can lead to variable and wide-ranging complications which are generally short term and not neurological. Health policy-makers should be aware that administration of general anaesthesia may need more personnel than needed to administer regional anaesthesia.
The incidence of neurological complications from regional anaesthesia ranges between 0 and 36 per 10 000 blocks, and most of the complications are due to nerve root damage caused by direct trauma from a needle or catheter (1).
In the studies included in this Cochrane review women had stated that for their next caesarean section operation they would prefer general anaesthesia. This may be due to the side-effect of regional anaesthesia such as nausea and discomfort or pain during the insertion of the needle or catheter. The review also found that women who had regional anaesthesia suffered less blood loss.
The discussion with women about the risks associated with the two anaesthesia options should be in the context of the specific health problems that women may have. Note that specific existing morbidities in individual patients may increase the risks associated with anaesthesia.
While women should be allowed to choose between the two options where they are available, availability of resources, including skilled personnel, will eventually determine the type of anaesthesia that is used.
AT HOME OR IN THE COMMUNITY
Women who choose regional anaesthesia should be advised to report to the health centre if they experience any complications such as headache, backache or neurological problems.
References
- Brooks H, May A. Neurological complications following regional anaesthesia in obstetrics. British Journal of obstetrics anaesthesia/CEPD Reviews 2003;3(4):111-4 DOI: 10.1093/bjacepd/mkg111.
This document should be cited as: Bamigboye AA. Regional versus general anaesthesia for caesarean section: RHL practical aspects (last revised: 29 November 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.