Review Note
Last Update: 03/02/2025 08:13 PM
Current Deck: ACG Part 2::Obstetrics
New Card (Unpublished)Currently Published Content
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Commit #293189
SS_OB 1.26 Evaluate the role of epidural, spinal, and combined spinal epidural techniques for caesarean birth
Back
Commit #293189- Spinal:
- Most commonly used technique
- Usually bupivacaine 0.5% 2.2 - 2.5mls + 15mcg fent + 100mcg morphine
- Can be performed quickly, even for some cat 1 sections
- Epidural
- Top up if in situ, 5-10mls at a time up to 20mls 0.75% ropivicaine or 2% lignocaine with adrenaline
- Lignocaine for speed, ropivacaine more reliable block.
- Useful in emergency LSCS if already in situ as avoids further procedures and could argue time
- Must establish adequacy of block prior to using
- Smaller doses in those with smaller epidural space (twins, obesity, polyhydramnios)
- Can also be used in elective surgery where gradual SNS blockade desirable (CHD, HTN)
- CSE
- Useful for longer procedures, obesity, complex surgery (e.g. >2x prev LSCS) or if epidural desirable post-op]
Regional advantages:
- Avoids GA risks
- Avoids neonatal depression
- Reduced blood loss
- Improved post-op pain relief
- Better birth experience for many (awake, partner in room)
- Early breastfeeding, no post-op drowsiness
Regional disadvantages:
- May take longer to establish block
- Some discomfort during surgery - pulling, tugging, pressure
- Hypotension, N&V, itch