Regional Anesthesia for Cesarean Delivery

ABSTRACT

During the last 2 decades, there has been an increasing impetus to avoid general anesthesia in women undergoing cesarean delivery because of the increased of failed endotracheal intubation in pregnant women compared with nongravid patients. The past decade has seen major changes in the practice of obstetric anesthesiology, as evidenced by an improved understanding by anesthesiologists of many disease entities seen in obstetric patients, as well as by the enhancements of new techniques and drugs. Recent advances in the practice of this specialty include the refinement of the combined spinal-epidural technique for both labor analgesia and cesarean delivery, the use of continuous infusions of dilute solution of local anesthetics combined with opioids, the development of multiorifice epidural catheters, the dramatic increase in the use of subarachnoid anesthesia for elective cesarean delivery, and the introduction of new amide local anesthetics. Because of the tremendous increase in the application of neuraxial techniques, the administration of general anesthesia for cesarean delivery has dramatically decreased. Also the number of deaths associated with regional anesthesia declined markedly with the withdrawal of 0.75% bupivacaine and probably due to increasing awareness of local anesthetic toxicity and increased use of test dosing. The discussion includes new methods and drugs associated with regional anesthesia for cesarean delivery and highlight their benefits and risks.