Caesarean section



If I had an epidural put in for labour pain, and I require a caesarean section, what happens to the epidural?

Provided that the epidural has been working well and it provided you with adequate pain relief from contractions, it can be used to provide anaesthesia for the caesarean section. However, an epidural for labour pain may not be adequate to provide anaesthesia for surgery because the medications used for labour pain may not have spread far enough to provide pain relief for the surgery. The anaesthetist will assess the adequacy of the epidural and, provided he or she is satisfied, may "top up" the epidural with more local anaesthetic with or without opioid drugs. If this is done it is a different anaesthetic.


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How will the anaesthetist make sure that I won’t feel pain during the caesarean section?

There are several ways to test the adequacy of the epidural or spinal block used to achieve an anaesthesia for caesarean section. Firstly, the anaesthetist will ask you to raise your legs one at a time. Known as straight-leg raising, this involves lifting your leg up straight off the bed, keeping the knee straight. In almost all cases of effective block, you should have limited ability to do that. Your legs may feel incredibly heavy, "concrete" like, and you will experience pins and needles. This is all indicative of a successful block. Secondly, the anaesthetist will test the level that the block extends up your body to determine its adequacy for surgery. This is done most commonly using ice. Temperature differentiation is controlled by the same types of nerves as pain transmission, so if you cannot appreciate the coldness of the ice you will not experience pain.


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