The three main types of anesthesia that are used for c-sections are: spinal, epidural, and general anesthesia. Spinal anesthesia is the most common followed by epidural. General anesthesia is much more rare and mostly used in very significant emergencies. Spinal and epidural anesthesia is considered regional anesthesia because it only numbs part of the body without affecting your cognition. In other words, you won’t feel the surgery but you will be awake and aware during the surgery.
Spinal anesthesia is administered through a needle that goes between the bones in your lower back and ends up in the spinal fluid. The spinal cord actually ends higher up than the end of the sac that contains the spinal fluid. This allows the anesthesiologist to place the needle in the fluid below the spinal cord. A mixture of numbing medication and pain medication is usually given. This will make you numb from the upper abdomen down to your toes. The numbness lasts about 2 hours. The pain medication lasts 12-24 hours. This makes your first day after a c-section much easier. Spinal anesthesia is extremely safe and effective. One risk is something called a spinal headache. This occurs when the fluid leaks out of the hole created by the needle. It is fairly uncommon. Spinal headache can often be treated by caffeine. If caffeine does not relieve the headache, a procedure called a blood patch can be done. To give a blood patch, the doctor will draw some of your blood, and then use it to place over the hole that is leaking spinal fluid. This generally works very well.
Epidural anesthesia for c-section is the same as an epidural for a laboring patient except more medicine is used. Like a spinal, a needle is placed between the bones in the back, but unlike a spinal it is not place all the way into the area with the spinal fluid. The needle is stopped just before it punctures the sac. Medication is then placed through the needle and that medication bathes the nerves as they leave the spinal canal. Like a spinal, both numbing medication and pain medication can be given. The epidural is adequate pain relief for a c-section but is not as deep a block as a spinal. This means that the feelings that work is being done is greater for an epidural then for a spinal.
With a regional block like a spinal or an epidural, sensations of movement are often still felt by the patient. It will not hurt, but for some people the feeling of work being done by the surgeon, even though not painful can be frightening. The surgeon will check the effectiveness of the block by pinching the skin with a surgical instrument. If this does not hurt, then the doctor knows that you are numb and the surgery will not be painful. If you experience anxiety during the c-section, medication can be given as soon as the baby is delivered. The anesthesiologist will wait until the baby’s umbilical cord is clamped, so this medication will not get to the baby. The anti-anxiety medication can sometimes cause loss of memory of the surgery itself and therefore of the first moments with the baby.
General anesthesia is when you are put completely to sleep. It is generally not the first choice. We use this in situations where we don’t believe that there is time for a spinal or epidural, or in cases when a spinal or epidural is not safe or will not work. These situations are rare. General anesthesia is very safe but there are more risks with this type of anesthesia then a regional block. General anesthesia is started with medication that puts the patient to sleep. A tube is then placed through the mouth into the breathing tube. A machine then breathes for the patient. Once the tube is in, gas can be administered to help keep the patient asleep. Sophisticated monitoring is done to keep the breathing, heart rate, blood pressure, and pain relief in the correct range.
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