A caesarean section can be planned in advance, but sometimes it is necessary to have it during labor. So knowledge of the methods of pain relief will be useful to all expectant mothers.
There are 2 main methods of anesthesia for caesarean section: general (or anesthesia), when you sleep during the operation, and regional (specific area is anesthetized), when you are awake, and the sensitivity of the lower body is blocked. Now Cesarean section is more often carried out under regional anesthesia.
Anesthesia is used when regional anesthesia is not possible (the doctor does not own the method, or the woman has contraindications).
Spinal – it is used most often in both planned and emergency operations. The drug is injected with the thinnest needle into the spinal space.
It is located in depth, along the entire length of the spine, in the form of a “bag” of dense shells. It contains spinal fluid and spinal cord with large nerves, responsible for the movement of the lower body.
The action of the drug occurs in 5 minutes and lasts longer than 1.5 hours.
Epidural anesthesia is used less frequently. The epidural space is located in front of the spinal, near the nerves that transmit pain from the uterus. After local anesthesia of the skin, a thin catheter is inserted into it through which the drug is administered.
This method is often used to relieve contractions. If there is a need for surgery, stronger anesthetics are injected through the same catheter.
But the dose of medication for epidural anesthesia will be greater than for spinal anesthesia, and it will not work as quickly – in 20-30 minutes. Because this method is used:
- if the epidural catheter has already been installed and there is still time before the operation, about 20 minutes;
- if a long operation is expected;
- when there is no experience in the use of spinal anesthesia;
- if an epidural catheter is required after surgery;
- There are contraindications to spinal anesthesia (heart defects, etc.).
Spinal-epidural anesthesia is a combination of both methods.
- With a planned caesarean section, it is better to be in the hospital a couple of days before the operation, but sometimes doctors are allowed to come on the same day.
- You will choose the method of anesthesia together with the anesthesiologist-resuscitator, and he will take your consent to it.
- The equipment in the operating room will constantly measure your blood pressure, pulse rate and blood oxygen saturation. The nurse anesthetist will then inject an intravenous catheter that supplies a solution that prevents blood pressure from lowering during the operation and makes up for blood loss. A thin catheter will be placed in your bladder (it will be removed after surgery).
You will be asked to lie on your side or sit on the operating table with your back arched. The doctor will find a comfortable place in the lumbar region and make an injection for local anesthesia on the skin.
SPINAL ANESTHESIA. Through the pain-free place, the doctor will insert the thinnest needle. With its progress, you can feel a backache in the leg.
Tell the doctor about it, but try not to change the position of the body. Through a needle, a dose of local anesthetic will immediately be injected and removed.
Usually, the procedure takes several minutes if there are no difficulties in moving the needle (as a rule, they are found in obese women and patients with severe scoliosis).
EPIDURAL ANESTHESIA requires a thicker needle in order to guide the catheter to the desired area. The needle insertion site is also anesthetized at first.
As in the case of spinal anesthesia, you may feel a slight backache in the leg, but try not to move until the catheter is installed and the needle is removed.
The main sign is that your legs will become warm, heavy and numb (later this sensation will reach the level of your chest). The doctor will check to see if you are ready for surgery.
If you feel nausea, thirst, weakness, report it to your doctor – this often happens with a decrease in pressure. To relieve the unpleasant symptoms, the doctor will inject the necessary drugs.
An obstetrician-gynecologist will treat your abdomen to the level of your breast with a sterilizing solution. A sterile screen will shield you from the surgical field. The operations of the obstetrician may be felt as light tugs or pressure.
An anesthesiologist-resuscitator will be close during the entire operation. To achieve sufficient depth of anesthesia, you can add a painkiller through an intravenous catheter or anesthesia.
After the baby is born, you will be given 2 drugs through an intravenous catheter: oxytocin – to help the uterus contract and separate the placenta, and the antibiotic – to protect against problems that can be caused by infection. And if necessary, there is also medicine that causes a feeling of peace, relaxation, and slight drowsiness until the end of the operation.
At the very end, you will receive the first intramuscular injection of the anesthetic, which will replace the passing action of regional anesthesia.
- Regional anesthesia and drugs associated with it are safer for women and children than anesthesia;
- it reduces blood loss during surgery;
- gives a woman the opportunity to see her child immediately after his birth (at the time of the operation, you can not remove glasses or lenses);
- does not cause drowsiness and disorientation after surgery;
- Helps prolong pain relief after surgery;
- allows you to get up early, start caring for baby and breastfeeding.
In addition, neither spinal nor epidural anesthesia does not cause chronic back pain and does not exacerbate long-standing problems with the spine.
- The combination of regional anesthesia with position on the back can cause a decrease in pressure before the start of the operation (this condition is corrected by medications);
- it happens, it takes more time than the preparation and conduct of anesthesia;
- very rarely, but the effect of such anesthesia may be insufficient;
- sometimes it causes chills and muscle tremors during and after cesarean section (these conditions are quickly treated with medication);
- headache may appear
- (1 case per 1000), which completely passes in a few days;
- sometimes anesthesia provokes slight loss of sensation and limitation of movement in the leg (1 case per 10,000). They can last several weeks and are more common after spinal anesthesia.
The first 2 hours you spend under the supervision of doctors. At this time, you may feel a slight chill, cramping contractions of the uterus; leg sensitization will gradually return. You can get up in 6-8 hours after surgery.
Choosing painkillers, doctors will focus on your feelings. The drugs can be injected into a vein, muscles, an epidural catheter, and with a tablet through the mouth.