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

Regional anaesthetic techniques are now the most frequently used type of anaesthetic used for caesarean deliveries. They have a better safety profile than general anaesthesia in the pregnant woman. The choice of whether to use a spinal, epidural or combined spinal-epidural technique will depend on patient and surgical factors. Particular care should be taken to those receiving therapeutic anticoagulation or with clotting abnormalities. Women should be provided with appropriate information to make an informed choice, including details of the intended risks and benefits of the technique. All women having caesarean deliveries must have vital sign monitoring, antacid prophylaxis and intraoperative venous thromboembolic prophylaxis. A left lateral tilt must be maintained until delivery of the baby. Breakthrough pain during caesarean delivery is a distressing complication and must be treated immediately. General anaesthesia should be offered and if declined, the woman's pain must be adequately managed with alternative analgesic methods. These include nitrous oxide, opioids and local anaesthetic infiltration.