C-section(CS) is one of the most common operations in obstetric practice, used in complicated pregnancy and childbirth, allowing to preserve the health and life of the mother and child. Like any surgical intervention, CS surgery requires pain relief. There are two most common methods - general anesthesia and epidural anesthesia. What determines the choice of anesthesia? What are the advantages and disadvantages of each? Let's figure it out.

Epidural anesthesia

Epidural anesthesia is a type of regional anesthesia that allows you to eliminate pain in a specific part of the body. In our case - at - in the lower half of the body.

Methodology

Preparation begins 30-40 minutes before surgery. A sterile needle is used to puncture the skin at the lumbar level and through intervertebral discs the needle enters the epidural space. The anesthesiologist then inserts a soft, thin plastic tube (catheter) through which the medicine (painkiller) will flow, and removes the needle.

information When the drug begins to act, the woman ceases to feel the lower part of the body: pain, temperature and tactile sensitivity disappears, approximately from chest level to the tips of the toes. At the same time, expectant mother clear consciousness remains: she hears, sees everything and can control her condition herself.

Advantages

• The woman remains conscious and is able to independently control her well-being, which allows her, if any discomfort occurs, to inform the anesthesiologist about it so that he can take measures to eliminate it;
• Remains relatively stable cardiovascular system in the mother, which avoids additional administration of other medications;
• The woman in labor breathes on her own, there is no need to intubate the trachea, which means that trauma and irritation of the upper respiratory tract;
• If it is necessary to prolong the operation, an additional dose of the drug can be administered through the left catheter, which will allow it to be extended for right time, and after the operation add narcotic analgesics to facilitate the postoperative period;
• The overall harm to the child from epidural anesthesia is not great due to the lack of many drugs used in general anesthesia. However, depending on what medicines were used (only anesthetics or also narcotic drugs), some complications are possible: decrease heart rate child, hypoxia, respiratory failure. With a competent approach from a pediatric neonatologist, all these complications can be easily eliminated.

Flaws

• Carrying out epidural anesthesia requires a highly qualified doctor, since the lumen of the epidural space is only 5 mm, there is a high probability of affecting the dura mater, which can subsequently lead to severe headaches (2% of cases);
• At least 20 minutes must pass from the time the drug is administered to the start of the operation, which makes it difficult to use this method in emergency cases;
• Sometimes the catheter may be placed unevenly, which can lead to unilateral pain relief and discomfort during surgical procedures. Therefore, before starting the operation, be sure to check sensitivity on both sides and only then proceed with the operation;
• In view of individual characteristics isolated damage to the body is possible nerve root needle or catheter with the subsequent occurrence of neurological complications (headaches that in rare cases may take several months).

General anesthesia

In most cases, this method of pain relief is used in emergency situations or when epidural anesthesia is not possible (there are contraindications or there is no proper technical support). The woman is unconscious throughout the operation and does not feel anything.

Methodology

General anesthesia for caesarean section is carried out in three stages. First, the woman is given a “preliminary anesthesia” intravenously, allowing her to fall asleep, then the trachea is intubated. A tube is inserted into the lower part of the windpipe, through which oxygen and anesthetic gas will subsequently flow. The third stage is the introduction of muscle relaxants, which relax all the muscles of the body, including the uterus. After this, the operation begins.

Advantages

• It does not take much time to induce anesthesia;
• Easier and most commonly practiced technique;
• There are practically no contraindications for use;
• Creates excellent working conditions for surgeons and anesthesiologists;
• The condition of the woman’s cardiovascular system during the operation is more stable.

Flaws

• There is a risk of lung aspiration from gastric contents;
• There may be difficulties with tracheal intubation, its traumatization and, as a result, the occurrence of sore throat, cough, respiratory tract infection, and pneumonia in the postoperative period;
• The large number of drugs administered during general anesthesia can have a negative effect on the mother and affect the baby;
• Anesthetics and narcotic substances used during anesthesia have a depressing effect on the child’s nervous system, resulting in lethargy, lethargy and drowsiness. They can also cause breathing problems in the newborn, which may require resuscitation by a neonatologist.

Which anesthesia should I choose?

At the stage of preparation for a planned caesarean section, in most cases the choice between general anesthesia and epidural anesthesia remains with the expectant mother. However, here it is necessary to take into account the equipment of the maternity hospital and the qualifications of specialists.

important In addition, if there are contraindications to epidural anesthesia (acute infectious diseases, injuries and diseases of the spine, blood clotting disorders, oblique or transverse position of the fetus), no matter how much you would like to be present at the moment the baby is born, for the sake of your safety they will not allow you to do so.

Let's summarize and compare these two types of anesthesia.

Epidural anesthesia	General anesthesia
The expectant mother is conscious and in control of the situation	Complete unconsciousness
You can see and hear the baby immediately after it is removed from the uterus	The child can be seen only a few hours after the operation
Numbness in the legs goes away 3-5 hours after surgery	After waking up from anesthesia, it takes time to recover
Headaches and back pain may occur in the postoperative period.	Cough, sore throat, headache– the most common symptoms occurring after general anesthesia
Less use of medications helps avoid complications in the newborn	Drugs adversely affect the baby’s nervous and respiratory systems

Additionally

There is another type of regional anesthesia - spinal. It differs from epidural anesthesia in that the drug is injected into the cerebrospinal fluid once, and a catheter is not used. Advantages this method is to make it easier technical implementation and the ability to use it in emergency situations. However, there is also a drawback: the amount of the administered drug must be strictly and correctly calculated for the duration of the operation, therefore, if unforeseen surgical complications arise and the need to extend the operation time, you will have to switch to general anesthesia.

Often during pregnancy or childbirth, indications arise that dictate the need for surgical delivery, that is. Of course, nowadays no one will “cut on a living” woman, so they use various methods pain relief for surgery. Which method will be used in a particular case depends on the choice of the pregnant woman, indications and contraindications, and, of course, on the preferences of the anesthesiologist.

Types of anesthesia used for caesarean section

To perform a caesarean section, two types of anesthesia are used: general anesthesia(anesthesia) and regional. Regional anesthesia is in turn divided into epidural (peridural) anesthesia and spinal anesthesia. Each method by which it is possible to extract it as painlessly as possible for a woman and safe for the fetus has its advantages and disadvantages.

General anesthesia

General anesthesia consists of administering medicines intravenously, while the patient is unconscious and loses tactile sensitivity. Since the patient cannot perform the most simple steps, including breathing, due to the influence of muscle relaxants that relax skeletal and smooth muscles, she is given artificial ventilation. To perform mechanical ventilation, the trachea is intubated, that is, a plastic tube is inserted into its lumen, through which oxygen from the ventilator enters the lungs. Therefore, anesthesiologists call such anesthesia endotracheal (ETN).

In modern conditions, general anesthesia has become less and less used, which is quite justified, but there are situations when it cannot be replaced by regional anesthesia.

Indications for general anesthesia for caesarean section:

• the woman is allergic to drugs used for regional anesthesia;
• the patient’s categorical refusal of spinal or epidural anesthesia;
• some obstetric situations, for example, transverse position of the fetus or prolapse of the umbilical cord loop;
• anatomical changes in the spine (spine surgery, spinal injuries);
• obesity of a woman;
• immediate surgery and pain relief are required (bleeding,);
• true placenta accreta.

Advantages of general anesthesia for caesarean section:

• almost instantaneous pain relief, which allows you to begin the operation as soon as possible (especially important in case of emergency caesarean section);
• much better tolerated by women;
• turns off consciousness 100%;
• complete relaxation of the muscles, which provides optimal operating conditions for the surgeon;
• stability of blood pressure and pulse, control of the patient’s breathing;
• if necessary, anesthesia can be prolonged through additional administration of anesthetics;
• All anesthesiologists are proficient in the ETN technique, which cannot be said about the skills of regional anesthesia.

Disadvantages of general anesthesia for caesarean section

The disadvantages of general anesthesia include its complications and consequences for both mother and child. First of all, an introduction narcotic drugs affects the fetus, it is in a state of narcotic sleep. Also, general anesthesia causes the development of depression in the child’s central nervous system, which affects his inhibition and even the occurrence of ischemic-hypoxic encephalopathy in the subsequent time. Therefore, it is not advisable to use general anesthesia for acute fetal hypoxia (although currently developed special drugs, minimizing risks). Many postpartum women after ETN complain of a sore throat and cough, which is caused by damage to the tracheal mucosa during intubation. The condition is unpleasant, but goes away in a couple of days. There is also a certain risk of aspiration syndrome (regurgitation of stomach contents into the respiratory tract), which can lead to respiratory failure and the development of pneumonia, which is difficult to treat. In addition, during general anesthesia there may be an increase in blood pressure and the occurrence of tachycardia.

Epidural anesthesia

Epidural anesthesia for caesarean section The essence of epidural anesthesia (EDA) is the introduction of anesthetic drugs into the epidural space. The epidural space is located between the hard meninges and intervertebral ligaments that connect the spinous processes of the vertebrae. The “injection” is done precisely in the area of ​​the ligaments, between the vertebral processes. Thus, numbness of the lower body is achieved.

The benefits of epidural anesthesia

• the woman is fully conscious and hears the baby’s first cry, and also has the opportunity to see him;
• the possibility of prolonging anesthesia if the operation is delayed, as well as pain relief in the early postoperative period (a permanent catheter is inserted into the epidural space);
• minimal risk of drug exposure to the fetus;
• relatively stable functioning of the cardiovascular system;
• good pain relief;
• motor activity is preserved to some extent;
• there is no risk of aspiration syndrome and trauma to the tracheal mucosa.

Cons of epidural anesthesia

• technically complex procedure;
• duration (up to 20 minutes) from anesthesia to the start of surgery;
• risk of intravascular administration of the drug (including seizures and death);
• injection of anesthetic subarachnoidally (under arachnoid membrane) and the development of a spinal block, which requires immediate resuscitation of the patient;
• the risk of inadequate pain relief remains.

Spinal anesthesia

Differences between spinal (spinal) and epidural anesthesia. Essence spinal anesthesia(spinal anesthesia or SMA) involves injecting an anesthetic into the space around spinal cord, which is washed by cerebrospinal fluid. That is, the same place between the vertebrae is pierced with a needle as during EDA, only a thinner needle is used, which in SMA must bypass the dura mater of the spinal cord.

Advantages of spinal anesthesia

• pain relief is achieved in 100% of cases, unlike EDA;
• anesthesia occurs much faster, after 5, maximum 7 minutes (surgeons do not wait and begin to wash themselves for the operation);
• technically, SMA is simpler than EDA;
• the cheapness of the method in contrast to epidural anesthesia;
• there are no risks of systemic effects of the anesthetic on a woman;
• the woman in labor is conscious and can hear and see the newborn;
• good muscle relaxation (optimal conditions for surgeons);
• absence negative action drugs for the fetus;
• less painful manipulation (the needle is thinner than with EDA).

Disadvantages of spinal anesthesia

• because of fast acting anesthetic, the level of blood pressure drops sharply (this moment is prevented prophylactically);
• It is not uncommon for post-puncture headaches to occur for several days (therefore, the patient is recommended to remain in a horizontal position for at least 24 hours after surgery);
• short duration of pain relief (no more than 2 hours) and inability to prolong SMA;
• Complications such as back pain for several months are possible.

If during pregnancy the mother has indications for surgical delivery, then she is prescribed elective surgery. It involves removing the newborn from an incision in the abdomen and uterus. Like any abdominal surgery, cesarean requires mandatory pain relief. Patients are often given a choice of the type of anesthesia, and many of them choose an epidural. Epidural anesthesia for caesarean section has specific features, advantages and disadvantages, which must be taken into account when choosing pain relief.

There are several common anesthesia options that are widely used for caesarean sections. These include:

1. General anesthesia. With such anesthesia, the woman is unconscious, she is immersed in a drug-induced sleep, in which there is no understanding of what is happening and no sensitivity. During endotracheal general anesthesia, a special tube is inserted into the trachea, which communicates with a device that provides pulmonary ventilation. This anesthesia begins to work almost instantly, so it is used when urgent surgery is necessary.
2. Spinal anesthesia belongs to the methods of regional anesthesia, which are safer for the baby and the woman in labor. Such anesthesia involves the introduction of a special anesthetic drug through a very thin needle into the cerebral fluid of the spinal canal. The procedure is practically painless and does not cause much discomfort, except for a slight feeling of pressure. To administer the anesthetic, the woman should lie on her side with her knees pressed to her stomach. As a result, the mother does not experience any painful sensations, she remains conscious throughout the operation, and after removing the baby she will be able to see him immediately.
3. Epidural anesthesia, like spinal anesthesia, is a regional type of anesthesia. According to the mechanism of action and conduction, it is close to the spinal one, although it has several differences.

Each technique is good in its own way, but there are also contraindications. More often than other types, epidural anesthesia is used for caesarean section.

Epidural pain relief

Anesthesia using this method is usually used for planned delivery operations, because it begins to act gradually, 20 minutes after the puncture. Such anesthesia does not require such high professionalism and precision as spinal anesthesia, since the drug is injected into the epidural spinal cavity. A needle is inserted between the spinal dura mater and the wall of the brain canal, through which a catheter passes. The needle is then removed, and an additional dose of anesthetic can be administered through the remaining catheter if necessary.

Epidural anesthesia is often used during traditional childbirth to eliminate pain and facilitate the process of natural childbirth in women with an overly heightened perception of pain. After administering the drug, the nerve roots begin to lose sensitivity, as a result, the woman soon ceases to feel the lower half of the body. Moreover, all types of sensitivity disappear: pain, thermal, tactile, etc. At the same time, the woman in labor is in a clear consciousness and can contact doctors. After a cesarean section, such anesthesia lasts for several more hours.

If the technique of administering the anesthetic was violated during the epidura, then pain relief may only spread to half of the body. If epidural anesthesia cannot be performed for some reason, then a cesarean section is performed under general anesthesia.

How is pain relief performed?

When a woman decides on the choice of anesthesia, her preparation begins, which includes psychological work, identifying possible allergic reactions, taking sedatives and so on. The patient must be examined: blood pressure, temperature and other health indicators are measured. Woman renting laboratory tests to determine rhesus, blood group, hemoglobin and red blood cells, leukocyte and platelet counts. A coagulogram is required to measure the concentration of prothrombin and fibrinogen.

After all the above procedures, if epidural anesthesia is approved, they proceed directly to the operation, which begins with the work of the anesthesiologist. A woman is introduced into peripheral vein catheter, connect the infusion system, install a cuff to control pressure, and prepare an oxygen mask. The woman is placed on her side and anesthesia is injected between the lumbar vertebrae, most often lidocaine is used.

During the entire operation, the patient is closely monitored, including monitoring respiratory functions and hemodynamic indicators such as pulse, heartbeat and blood pressure. Typically, the effect of the epidura lasts for several hours after surgery.

The benefits of an epidural

Doctors can perform such anesthesia for caesarean section in two ways: with or without a catheter. When inserting a catheter, a small dose of anesthetic is initially injected, and then an additional dose is given if necessary. If a catheter is not installed, then the drug is immediately administered in a large dose so that its effect is sufficient for the entire operation.

The use of an epidural during surgical delivery has some advantages, for example, the absence of side effects oxygen starvation the fetus and the woman in labor, which is observed during general anesthesia against the background of repeated insertion of a tracheal tube or due to an incorrectly configured pulmonary ventilation device. There are other advantages of such pain relief:

• During the entire cesarean procedure, the patient remains fully conscious and understands what is happening around her, so it remains possible to hear and see the baby immediately after its removal;
• There is no irritation factor associated with damage to the airways during intubation;
• During the operation, relatively stable cardiovascular functioning is ensured;
• The anesthetic drugs used are not capable of causing toxic harm to the fetus;
• Epidura provides a fairly long-lasting analgesic effect, so it is successfully used during natural childbirth, cesarean sections are performed with it, etc.;
• It is permissible to use anesthesia on a non-empty stomach, whereas general anesthesia requires abstinence from food.

Epidural pain relief is very effective against post-operative pain syndrome, when appropriate drugs are administered through a catheter after the intervention, therefore such anesthesia is widely used in surgical practice.

When is such anesthesia indicated?

In order for a caesarean section to be performed with epidural anesthesia, a number of relevant indications are taken into account. Such anesthesia is recommended if a woman in labor has pathological abnormalities such as diabetes mellitus or gestosis, heart defects or hypertension, at different kidney diseases. In addition, an “epidural” is performed in a situation where at the beginning natural birth A similar anesthesia has already been used for pain relief, but complications have arisen and the patient urgently needs to undergo a delivery operation.

Similar anesthesia is also indicated for premature pregnancy, if the pregnant woman has liver disorders, with cervical pathologies or excessive uterine activity. If contraindicated general type anesthesia, then the woman in labor also undergoes a cesarean section with epidural anesthesia.

Epidure, in comparison with general anesthesia, is a more gentle and safe procedure for the child, but when choosing anesthesia, a specialist always evaluates the general condition of the mother and fetus.

Disadvantages of epidural anesthesia

Although there are many advantages, epidural anesthesia for caesarean section also has some disadvantages. Such injections help reduce blood pressure, which in some situations can provoke a pronounced nausea attack and severe dizziness during the operation. Failure to comply with the technique of administering the anesthetic may result in seizures and a rapid decrease in blood pressure, which can lead to serious brain damage and even death.

The influence of drugs on the fetus cannot be ruled out, although it does not enter the child’s body directly; it can negatively affect it through complications on the mother’s body. If for some reason the delivery operation lasts for more than two hours, then the epidural will have to be extended, that is, increased doses of anesthetic medication will have to be administered. It can also negatively affect the newborn.

Contraindications to this type of anesthesia

To avoid possible negative consequences, it is necessary to take into account some requirements for this type of anesthesia. Of course, doctors will not give such pain relief to a woman if she herself refuses it. In addition, it is impossible to provide complete epidural pain relief in the absence of necessary equipment, materials, as well as the specialization of the anesthesiologist. Also contraindications include:

Therefore, when choosing such anesthesia, you should definitely take these contraindications into account. Otherwise, there is a high risk of developing undesirable consequences that are dangerous for the fetus and mother.

Possible adverse reactions and negative consequences

Typically, epidural anesthesia rarely causes any complications, but if the anesthesia technique is not followed, the patient may face similar consequences. The feeling of numbness, goosebumps and tingling in the limbs, which occurs in the first minutes after the administration of the medication, is considered quite natural. This is a normal reaction indicating the onset of action of the anesthetic drug. Such sensations will disappear after stopping therapeutic effect medicine. Also normal reaction Spontaneous trembling, which subsequently goes away on its own, is considered to be considered.

If the sterility at the puncture site is compromised, inflammatory processes, for the elimination of which the use of local antibiotics in the form of solutions or ointments is indicated. If during the operation a woman’s blood pressure drops sharply, then the consequences of epidural anesthesia in the form of a nausea-vomiting reaction, which is eliminated by normalizing blood pressure, are possible. For this, cardiotonic drugs like Metasone or Epinephrine are prepared in advance.

Sometimes with insufficient preoperative preparation a woman in labor may experience sudden allergic reaction for anesthetic. Then it is necessary to stop its administration and stop the attack with antiallergic drugs such as Dexamethasone or Suprastin. If during the administration the anesthesiologist mistakenly pierced the dura mater, the woman in labor will subsequently experience severe headaches. In such a situation, daily bed rest is necessary; you are allowed to get up only the next day. This purpose is caused by an increase in pressure in spinal canal in an upright position, resulting in fluid leakage, leading to headaches. In addition to bed rest, taking painkillers like Analgin, etc. is recommended.

It happens that women complain of pain in the back, the causes of which are associated with traumatic damage to the spinal nerve root during the puncture process. If an anesthetic is introduced into a vessel by mistake, acute systemic intoxication may develop. To avoid this, an aspiration check is performed or a test dose is applied. According to statistics, adverse reactions or complications arise when contraindications to the use of such anesthesia are not observed.

There is no anesthesia that does not have any contraindications. If a caesarean section is planned in advance, then the type of anesthesia is selected taking into account the wishes of the woman in labor, but contraindications and indications are also necessarily taken into account. There are specific criteria by which the most optimal pain relief is determined.

1. The general condition of the woman in labor and the presence of certain pathologies in the anamnesis. If the patient has reduced blood clotting or there are pathologies such as lumbar osteochondrosis, then spinal and epidural anesthesia is unacceptable. If the pregnant woman has a family history of hyperthermia of a malignant nature, then general anesthesia is contraindicated.
2. Planned duration of the procedure. If additional surgical procedures are planned during a caesarean section, then a general type of anesthesia is prescribed; for uncomplicated delivery operations, the choice remains with regional anesthesia. Epidural anesthesia provides a longer anesthetic effect than spinal anesthesia, but less profound. With any regional anesthesia, a decrease in pressure is noted, which, with a long-term effect, can lead to fetal hypoxia.
3. Consideration of indications for delivery surgery. In case of emergency intervention, the choice falls on general anesthesia, because it acts instantly. A planned cesarean section allows the use of local types of anesthesia, in which the woman will be conscious, thanks to which she will be able to see the baby immediately after extraction and hear his first cries.

Less dangerous for the patient and baby local methods anesthesia, but the final choice is determined together with the doctor based on the specific case.

What doctors say

Doctors insist that epidural pain relief is permissible only for appropriate indications. Today, many patients, because of the fear before childbirth, literally demand such anesthesia for natural, uncomplicated childbirth. Typically, women in labor begin to require pain relief when labor is almost over. And at this time, pain relief is categorically unacceptable, since anesthesia will negatively affect contractions, and the woman in labor will not be able to push the baby out on her own.

Epidural anesthesia is more of a surgical intervention into the spinal structures, rather than a harmless pain-relieving injection. Even with today's safe, reliable and advanced medical technologies the possibility of complications cannot be excluded. Therefore, during caesarean section, epidural anesthesia is optimal method pain relief, but during natural childbirth it is better to refuse it.

Hello friends! This is Lena Zhabinskaya! Surgery requires mandatory pain relief. Initially, mothers were offered only general anesthesia, but over time everything changed. Today, 4 types of anesthesia are used in medical practice. Each has advantages and disadvantages. How to choose the best one?

Just read today’s article, which talks about which anesthesia is better for a caesarean section.

Nature provides that a woman should give birth naturally. Due to the fact that sometimes it was problematic to implement this, medicine proposed a radical, but in some cases the maximum safe option delivery - caesarean section. Its essence lies in the fact that the doctor performs a surgical operation, thanks to which the fetus is removed through an incision in the uterus and peritoneum.

By the way, the procedure goes back to antiquity. According to myths and legends, it was thanks to Caesarean section that the world saw the god Apollo. It is worth noting that before early XVI centuries, caesarean sections were performed only when the woman in labor died. But in 1500, a description appeared of the first case in Europe of a child being born through surgery, as a result of which both mother and child remained alive.

Anesthesia was first used in the mid-19th century. Its goal is to provide maximum pain relief, allowing the woman to tolerate the upcoming operation well. The latter is performed for several minutes, during which an incision is made in a certain place to remove the child. If there are no complications, the woman is discharged 5–6 days after the operation.

The absolute indications for its implementation are:

• discrepancy between the size of the fetus and the woman’s pelvis;
• clinically narrow pelvis;
• placenta previa;
• risk of uterine rupture during childbirth;
• fetal malformations.

Anesthesia is always used.

Anesthesia: types and contraindications

A pregnant woman who is scheduled for a caesarean section can choose one of four types of anesthesia. It's about O:

• epidural;
• spinal;
• general anesthesia;
• endotrachial anesthesia.

Each has pros and cons, and is also used strictly according to indications. Local anesthesia They do not do it during caesarean section. Despite the refinement of the technique of performing the operation, there is always a minimal risk of exposure to the anesthetic on the child. Therefore, when making your choice in favor of one type or another, you should weigh the pros and cons.

Epidural anesthesia

Epidural anesthesia, epidural, epidural anesthesia - as soon as young mothers do not call this type of anesthesia. Despite the variety of terms, its essence boils down to one thing: an injection is given in a certain place under the spine in the lumbar region. In this way, doctors gain access to the area where the nerves of the spinal cord pass and periodically inject an anesthetic into it through a catheter.

The main advantage of such anesthesia is clarity of consciousness. After administration of the drug, the patient does not fall asleep, but simply ceases to feel everything that is below her waist. She cannot move her legs, but she also does not feel any pain in the abdominal area. Often such anesthesia is given to young mothers during natural childbirth so that they can follow all the doctor’s instructions and give birth to the baby painlessly.

Its other advantages:

• eliminates the risk of irritation of the upper respiratory tract, which is great news for women with bronchial asthma;
• The functioning of the cardiovascular system is not disrupted due to the gradual increase in strength of the drug;
• the relative ability to move is preserved, which is extremely important in the presence of diseases of the muscular system;
• due to the presence of a catheter, the duration of the operation is adjusted (in other words, if necessary, doctors administer an additional dose of the drug);
• thanks to this injection, it is resolved by the introduction of painkillers into postoperative period– opioids.

The main indications for its implementation:

• premature birth at less than 37 weeks;
• gestosis or high blood pressure which successfully goes away thanks to an epidural;
• incoordination labor activity due to the pronounced effects of oxytocin;
• long labor that exhausts a woman, not allowing her to fully rest and recuperate.

There are also contraindications:

• disruptions in the process of blood clotting;
• infectious diseases;
• allergic reaction to the drug used;
• transverse or oblique position of the fetus;
• discrepancy between the weight of the child and the mother’s pelvis;
• sometimes a scar on the uterus;
• the presence of pustules directly near the puncture site;
• spinal deformities.

Despite all the advantages described above, you cannot blindly agree to this anesthesia. Its disadvantages:

• Risk of intravascular or subarachnoid injection. In other words, the anesthetic enters the vessels or arachnoid membrane of the spinal cord, as a result of which a woman may develop convulsions and hypotension.
• Difficulty performing the procedure.
• The need to wait 15–20 minutes before performing the operation.
• Sometimes there is partial anesthesia, resulting in severe discomfort during surgery.
• The risk of penetration of the anesthetic through the placenta and depression of the child’s breathing and heart rate.

The consequences of epidural anesthesia are also sometimes disastrous. These include back pain, headaches, problems with urination, and tremors in the legs. For more information about this, watch the video.

Spinal anesthesia

In general, this type of anesthesia is practically no different from the previous one. As before, the woman is given an injection in the back, but this time the needle is inserted deeper, piercing the dense membrane that surrounds the spinal cord. That is why such anesthesia is called spinal. The injection is placed strictly between the 2nd and 3rd or 3rd and 4th vertebrae to exclude the possibility of damage to the spinal cord. The needle is used thinner and less drug is injected.

Spinal anesthesia has its advantages:

• complete pain relief;
• fast action - the operation begins a few minutes after its administration;
• minimal risk of developing consequences as a result precise definition injection sites;
• absence of toxic reactions in response to improper administration;
• comparatively cheap compared to other types of anesthesia.

Disadvantages of puncture:

• short duration of impact on the body - only 2 hours;
• small risk of a drop in blood pressure due to rapid administration of the drug;
• the risk of headaches in the frontotemporal lobe, which persists up to 3 days after surgery.

Spinal anesthesia Do not do it if there are contraindications, which are:

• rash at the puncture site;
• circulatory pathologies, blood clotting disorders;
• sepsis;
• neurological diseases;
• diseases of the spine.

General anesthesia

It is worth noting that currently general anesthesia is used extremely rarely during caesarean section. This is explained by its detrimental effect on the health of the mother and child.

The essence of the procedure is the intravenous administration of an anesthetic, which takes effect within a few seconds. After this, a tube responsible for supplying oxygen is inserted into the trachea. There are few indications for this type of anesthesia:

• bleeding, obesity, spinal surgery, bleeding disorders, due to which other types of anesthesia are not acceptable;
• abnormal position of the fetus or prolapse of the umbilical cord;
• emergency surgery.

Advantages:

• rapid pain relief;
• stable functioning of the cardiovascular system;
• simplicity and ease of the procedure.

Flaws:

• the risk of aspiration, when stomach acid enters the lungs and causes pneumonia;
• risk of depression of the child’s central nervous system;
• oxygen starvation of the woman in labor;
• risk of hypertension and increased heart rate.

How long does it take to recover from anesthesia? Doctors say several hours. Meanwhile, in fact, women can feel it even after a few days harmful influence on oneself, which is expressed in muscle pain, dizziness, nausea, cough, injuries oral cavity.

Endotrachial

Endotracheal anesthesia involves the administration of a drug intravenously, after which a tube is inserted into the trachea to provide artificial ventilation. Through it, an anesthetic also enters the woman’s body, which eliminates the risk of pain. It is used for urgent operations or sudden deterioration in the condition of the mother and fetus.

This anesthesia is contraindicated for bronchitis, pneumonia, tuberculosis, and heart disease. It is also worth noting that it quickly relieves pain. How long does endotrachial anesthesia last? It all depends on the time of the operation, since the drug can be additionally administered if necessary.

Its consequences:

Comparative table of different types of anesthesia

To finally understand under what better with anesthesia The following table will help you perform a caesarean section:

Type of anesthesia	Pros	Cons
Epidural	Clear consciousness, possibility of use for women with bronchial asthma, muscle pathologies, possibility of repeated administration of the drug during surgery	The risk of incorrect administration, the need to wait time before starting the operation, the risk of partial anesthesia and discomfort in the mother, depression of the cardiovascular and respiratory systems in the newborn
Spinal	Complete anesthesia, possibility of emergency surgery, precision of puncture, comparatively cheap, effect of the drug up to 120 minutes	Possibility of headaches in the first 3 days after surgery
General anesthesia	Possibility of emergency surgery, duration of action up to 70 minutes, minimal contraindications	Risk of injury to the oral cavity, dizziness, confusion in the mother and depression of the central nervous system and breathing in the child
Endotrachial	Fast pain relief, possibility of prolongation of action	Consequences for the mother in the form of cough, oral injuries and for the child - in the form of respiratory depression, nervous system

Which one to choose

Choose best anesthesia during surgical intervention, only a doctor can do it based on medical history, because each procedure has its own advantages and disadvantages and affects both the condition of the mother and the condition of the child. And these are not empty words, but reviews from women who have given birth.

Therefore, do not neglect his advice. And also share the post on social networks and subscribe to updates. It was Lena Zhabinskaya, bye everyone!

Caesarean section is a surgical procedure in which the newborn is removed using an incision abdominal wall and the uterus. Thanks to this procedure, thousands of children are born every year, so the question of how it is carried out this operation worries many expectant parents. At the same time, one of the most important points Something to think about before giving birth is the type of pain management.

So, which anesthesia is better for a caesarean section? From the article you can learn basic information about the most commonly used types of pain relief during this operation, their main advantages and disadvantages.

How is surgery performed?

Before you find out which anesthesia is better for a caesarean section, you should say a few words about the essence of this surgical intervention.

During a caesarean section, the newborn is not born naturally(through the birth canal), and is removed through a small incision that the surgeon makes on the wall of the uterus. In modern maternity hospitals, the incision is made in the lower abdomen, making the scar after the operation almost invisible. Similar method obstetrics is very common and widely used in practice: in some European countries, for example in Germany, up to 40% of babies are born this way.

There are two types of surgical intervention: planned and emergency. The first is done if there is a risk of developing any complications during natural childbirth that threaten the life and health of the mother and baby. Indications for this operation include the mother’s pelvis being too narrow, the threat of hypoxia, labor that has begun ahead of schedule, multiple pregnancy, etc. Naturally, planned surgical intervention is the more preferable option, since there is time to prepare the woman in labor for the upcoming operation.

Emergency surgery is performed if any problems arise during natural childbirth. dangerous complications. At the same time, emergency surgery in most cases is carried out using general anesthesia, one of the main advantages of which is the rapid onset of the anesthetic effect: this is very important, because sometimes during complicated childbirth the minutes count.

Naturally, such surgery is unthinkable without the use of anesthesia, otherwise the patient may not survive the painful shock.

What types of pain relief are used for caesarean section?

There are two main types of anesthesia that can be used during a cesarean section: regional and The first completely deprives of sensation only the lower half of the body, while with general the patient’s consciousness is completely turned off and all her muscles relax. At the same time, the choice of adequate and most suitable method Anesthesia can only be administered by a doctor, taking into account the characteristics of pregnancy, the mother’s health status and many other factors.

Types of anesthesia for caesarean section:

• general anesthesia;
• spinal;
• epidural.

The main advantages and disadvantages of each of them are described below.

When can the choice be made in favor of general anesthesia?

The essence of general anesthesia is that, thanks to a complex of drugs that are injected into the venous bloodstream or through a tube inserted into the respiratory tract, the patient completely loses consciousness and ceases to experience pain. It is important to note that during general anesthesia, muscle relaxation is observed, which makes it possible to create comfortable working conditions for the obstetrician surgeon.

This type of pain relief for women undergoing cesarean section is relatively rarely chosen. The need for general anesthesia may arise in the following cases:

• presence of contraindications to others existing methods pain relief;
• the woman in labor is obese;
• the fetus is diagnosed with hypoxia;
• woman’s refusal to use other types of pain relief;
• abnormal position of the fetus in the uterus, prolapse of the umbilical cord and other obstetric emergencies.

Nowadays, caesarean section is used if there is a need to perform it according to emergency indications, and surgical intervention must be started urgently to save the lives of the woman in labor and the child. This is due to the fact that general anesthesia has a number of significant disadvantages.

Disadvantages of general anesthesia

What anesthesia is better for caesarean section? Before answering this question, let's talk about its disadvantages. Doctors try to avoid this type of anesthesia during cesarean section, since anesthesia can cause many more complications compared to other pain management methods. Among the most common it is worth highlighting:

• hypoxia of the woman in labor, which is caused by the fact that during anesthesia the volume of the lungs decreases and the body’s need for oxygen increases;
• there is a high risk of aspiration, that is, gastric contents entering the respiratory tract: if the anesthesiologist does not diagnose in a timely manner this state, the consequences can be dire;
• Many women in labor experience increased blood pressure during general anesthesia.

The anesthetic can lead to disruption of the newborn's respiratory activity, as well as have a depressing effect on his nervous system due to the penetration of painkillers through the placenta. The latter is especially dangerous if general anesthesia is used for premature birth. However, there is no need to be too afraid: modern drugs make it possible to reduce the risk of developing negative consequences for the child to a minimum; in addition, the newborn receives special medications that relieve the effects of general anesthesia.

Thus, which anesthesia is best for a caesarean section is up to you and your doctor to decide, but remember that general anesthesia is far from best way anesthesia for the operation, and should be resorted to only if there are no other options left for one reason or another. For example, if a woman in labor has an unstable psyche or suffers from any psychiatric illnesses, the operation can only be performed under general anesthesia, because there is a high risk that the woman will not be able to remain calm during the operation and will interfere with the surgeon’s actions.

Much more often in practice, epidural and spinal anesthesia are used, that is, regional methods of pain relief - these types are much safer, and also allow the woman to be in a state of clear consciousness during childbirth. This is important not only because she has the opportunity to immediately hold the newborn. During a cesarean section, the obstetrician and anesthesiologist can maintain constant contact with the patient, which makes it easier to identify possible complications.

Epidural anesthesia procedure

Before answering the question of what is the best anesthesia for a caesarean section, it is worth finding out what it is. This is a procedure in which an anesthetic is injected into the epidural space of the spine in the lumbar region. After anesthesia produced by this method, the woman in labor remains conscious during the operation, but does not experience any pain.

With a caesarean section, it allows the woman to take an active part in the birth process: communicate with medical personnel or the spouse present in the room, immediately pick up the newborn and put him to the chest. In this case, the woman in labor does not feel pain, although some note slight discomfort during the operation.

True, there is one very important nuance. It is psychologically difficult for many women to decide to stay in the operating room; they are afraid that during a caesarean section they will be conscious and not feel half of their body. Often, women in labor insist on general anesthesia. It is advisable to discuss your fears with your doctor and anesthesiologist, who will tell you in detail how the pain relief procedure will proceed.

Advantages of epidural anesthesia

Among the main advantages of epidural anesthesia are the following:

• Stable functioning of the cardiovascular system, absence of pressure surges.
• Maintaining the ability to move.
• There is no injury to the upper respiratory tract and there is no risk of aspiration.
• Long duration of anesthetic effect. If necessary, anesthesia can be extended for any period of time, which is very important if, after a cesarean section, it is necessary to perform any other operations, for example,
• The woman recovers from anesthesia quite quickly, the period is shortened postoperative recovery: Just 24 hours after surgery, many patients can get up and move around independently.
• The baby can be picked up and placed to the breast immediately after the operation.
• It is possible to reduce pain after childbirth by injecting painkillers into the epidural space.

Disadvantages of epidural anesthesia

Despite all its benefits, the consequences of epidural anesthesia for caesarean section can be disappointing. Every expectant mother in labor should know this:

• If the anesthetic is administered by an insufficiently experienced specialist, there is a high risk of the drug entering the bloodstream. At the same time, convulsions develop, blood pressure drops sharply and consciousness is depressed. The result may be the death of the mother in labor or irreversible damage to the nervous system.
• In about 17% of cases, the anesthesia fails to block some nerves, causing the mother to experience pain during a cesarean section. discomfort. Therefore, before starting surgery, it is necessary to check sensitivity using special neurological tests, such as pin pricks. If the anesthetic does not work properly, repeated administration of the drug is required.
• If the medication gets under the arachnoid membrane of the spinal cord due to improper insertion of the catheter, a spinal block may occur, which often results in failure of the respiratory system. To avoid this, a small dose of the drug is first administered: surgical team it only takes two minutes of waiting to determine if the procedure has been performed correctly.

Unfortunately, epidural anesthesia for cesarean section is quite complex, and its success often depends on the experience and skills of the specialist. Tactile detection of the epidural space is rather indistinct, while a reliable marker is the exit to the surface cerebrospinal fluid. Therefore, it is important to choose a doctor you trust and carefully study reviews about the work of the maternity hospital where your baby will be born.

Spinal anesthesia

At first it seemed like a real salvation, because it not only made it possible to make the process of giving birth to a child completely painless, but also gave women the opportunity not to lose clarity of thinking and perception at the moment of the birth of the long-awaited baby. However, due to numerous contraindications and the likelihood of a number of negative consequences listed above, epidural anesthesia is gradually giving the palm to spinal anesthesia. Many claim that this is the best anesthesia for caesarean section.

Spinal anesthesia involves the injection of an anesthetic into the lumbar region of the back. The drug enters the subarachnoid space of the spinal cord. Moreover, the effect of both types of anesthesia is similar: some time after the injection, the woman in labor ceases to feel the lower half of her body, and the doctor can begin the necessary surgical procedures.

Pros of spinal anesthesia

What anesthesia is best for caesarean section? It is quite difficult to answer this question, since everything is individual. But we can highlight the main advantages of spinal anesthesia:

• No toxic effect. If the anesthetic accidentally gets into the bloodstream, there are practically no reactions from the heart or nervous system, and there is no risk to the child.
• After the operation, the body recovers quite quickly.
• High-quality pain relief: during the operation, the woman in labor does not experience pain.
• Spinal anesthesia additionally relaxes the muscles, which makes the doctor's work easier.
• The operation can begin a few minutes after the drug is administered, so the intervention takes less time.
• Spinal anesthesia is much easier to perform than epidural. In addition, the anesthesiologist uses a much thinner needle to administer the drug, thereby minimizing the risk of spinal cord injury or erroneous administration of the anesthetic.
• Many doctors recognize spinal anesthesia as the most advanced option for cesarean section anesthesia.

for caesarean section: contraindications and main disadvantages

Unfortunately, spinal anesthesia has some disadvantages:

• The drug is effective for two hours, so this type pain relief will not be suitable if any additional manipulations need to be performed, and if complications arise during the operation, additional anesthesia may be required.
• Spinal anesthesia is not possible if the patient has certain types of spinal injuries.
• Because of quick start anesthesia may decrease blood pressure.
• If the instruments used to administer the drugs were not thoroughly disinfected, various infectious complications, such as meningitis, may occur.
• After surgery, many women in labor experience severe headaches that can last for several days or even weeks.
• As a result of incorrect insertion of the catheter, the nerve center called the cauda equina can be damaged. This may cause the innervation of the sacrum and lumbar region will be broken.
• Spinal anesthesia is not possible for some forms of spinal deformity.
• Spinal anesthesia is not possible with premature detachment placenta and some other obstetric conditions.

Despite the disadvantages listed above, spinal anesthesia is considered one of the best and safest techniques for pain relief during caesarean section.

Pain relief for caesarean section: reviews

What anesthesia is better for caesarean section? Feedback about how women feel during this or that type of anesthesia will help us find the answer to this question.

Young mothers note that the process of emerging from general anesthesia is quite unpleasant: there is a feeling of clouding of consciousness, nausea, headaches and muscle pain. In addition, there is no opportunity to hold the baby in your arms immediately after birth. There is another negative consequence of general anesthesia: often after it the child experiences respiratory depression.

What anesthesia is better for caesarean section? Reviews about epidural anesthesia are mostly positive. Mothers in labor note that after the procedure there are no unpleasant sensations, and the baby can be immediately put to the breast. True, as reviews indicate, there are often unpleasant sensations in the area where the drug is administered, and in the first few hours after a cesarean section, when the anesthetic is removed from the body, the lower half of the body trembles violently. However, just a day after the operation, it is possible to get on your feet, move independently and care for the newborn.

Spinal anesthesia has generally received positive results. Patients note that they did not experience pain during the operation. However, in some cases, women suffer from headaches and abdominal discomfort for several weeks.

How to choose anesthesia?

So which anesthesia is best for a caesarean section? This article aims to familiarize expectant mothers with what types of anesthesia are used to relieve pain during a caesarean section. But remember, in no case should you be guided by the above information when choosing anesthesia! Only a doctor who has all the data on the health status of the mother in labor can choose the right type of pain relief. Of course, the patient’s wishes cannot be ignored. Therefore, before deciding which anesthesia is best for a caesarean section, you should weigh all the pros and cons of one method or another, and consult with a surgeon and anesthesiologist.

In order for the chosen anesthesia to be successful, it is necessary to follow all the recommendations of specialists who will advise how to eat on the eve of the operation, when to get up after a caesarean section and what to do to ensure that the body recovers as quickly as possible.