[Spinal or epidural anaesthesia for caesarean section? Compared opinions]

Regional anaesthesia during caesarean section reduces mortality directly related to anaesthesia. Epidural anaesthesia is a good choice when an epidural anaesthesia was performed during labor. General anaesthesia is recommended only for emergency caesarean section and when regional anaesthesia is contraindicated. The Authors describe the reasons for choicing an epidural or a spinal block. Main points supporting spinal block are facility in performing, quickness of the achievement of the block and a good quality of sensorial and motor block. On the other side epidural anaesthesia makes the anaesthesist able to titrate with exactness the level of sensorial block and offers a good postoperative analgesia. Because of the introduction of atraumatic needles PPDH has drammatically decreased: accidental PPDH takes place in a small but ingrained percentage. Recently spinal block has been described as a reliable choice even in preeclampsia and in pregnancy hypertension. Epidural opiates have a lower incidence of maddening side effects compared with spinal opiates and allow better maternal satisfaction as regard postoperative analgesia. In accordance with ASA guidelines there are no decisive reasons in order to choice spinal or epidural block: actually literature is unable to give a definitive suggestion about complications and advantages. The choice would be take place weighing up maternal wishes, fetal factors (elective versus urgent caesarean section) and the preferences of the anesthesiologist.