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Caesarean section under local anaesthesia: back to basics.

Ganesh Shinde¹, Neha Sharma, Balaji Jadhav

¹Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, Maharashtra, India. contactgshinde@gmail.com

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Summary

This summary is machine-generated.

Caesarean section under local anaesthesia (CSLA) is a life-saving procedure for high-risk pregnancies, particularly in rural areas. This technique, using lidocaine, avoids complications associated with general or regional anaesthesia.

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Area of Science:

Obstetrics and Gynecology
Anesthesiology
Public Health

Background:

Eclampsia is a severe complication of pregnancy characterized by seizures.
High-risk pregnancies often necessitate careful anesthetic choices to minimize maternal and fetal risks.
Previous lower segment Caesarean section (LSCS) can influence anesthetic management in subsequent deliveries.

Observation:

A gravida 2 para 1 living 1 patient with eight months amenorrhea presented with uncontrolled, refractory eclampsia and intrauterine fetal demise.
The patient had a previous lower segment Caesarean section and was classified as ASA Grade III, indicating very high risk for mainstream anesthesia (general/regional).
A Caesarean section under local anaesthesia (CSLA) using 0.5% lidocaine was performed due to the high-risk profile.

Findings:

CSLA was successfully performed using 0.5% lidocaine in a high-risk eclampsia patient with intrauterine fetal demise and prior LSCS.
The use of local anaesthesia avoided the potential complications of general or regional anaesthesia in this ASA Grade III patient.
The anaesthetist remained on standby to manage any potential complications, ensuring patient safety.

Implications:

CSLA should be recognized as a vital, life-saving procedure, not a suboptimal approach, especially in resource-limited settings like rural India.
This technique offers a viable alternative for managing high-risk obstetric patients where general or regional anaesthesia poses significant risks.
The availability of anaesthetists on standby is crucial for the safe implementation of CSLA in complex cases, mitigating risks associated with mainstream anaesthesia.