Hypothetical question about epidurals and cs

[eilidhfi]

I had a very long labour with dd and eventually agreed to have an epidural so I could get some rest. So the anethetist came and tried 8 times to get the needle thing in my back. Eventually she gave up, declared I have scoliosis and left. So I've since been checked for scoliosis and there's a slight curve in my spine which will probably never effect me apart from I can't have an epidural.

Sooo my question is if for some reason in a future pregnancy I need to have a cesarean would I have to be put under general anasthetic? Or is being numbed for a section completely different to having an epidural?

[interested emoticon]

[mummyclare]

Poor you. If you needed a section they e
would get the consultant to do it and they would in all probability succeed.

[Mintpurple]

A large precentage of people have some degree of scoliosis and it doesnt affect the siting of an epidural, although it can give a bit of a 'one sided' block in a severe case.

I think you more likely had a case of a crap anaesthetist - we have the occasional one in our labour ward who just cant get an epi in or they never work etc.

What I suggest (and what we do in our hospital) is that when you are pregnant, make an appointment to see one of the anaesthetic consultants who will assess your back and discuss your options with you.

I think you will find that the consultant will confirm a slight scoliosis but that you should be ok for an epi - hopefully you will get a better anaesthetist next time (mostly they are really very good at their job, but just occasionally......)

[eilidhfi]

Thanks for your replies. I wasn't very impressed with the woman that did it (or didn't do it!) but very interesting that you both think an epi could be done. I'm not very worried about it cos I managed perfectly well with g&a in the end so hopefully that's all I would need if/when I do have another lo.

Never thought I'd be so preoccupied with my relatively normal labour!

[ajm200]

Ask to see a consultant now to find out what your options are

I had a patchy epidural last time and have nothing wrong with my back. The anaesthetist just didn't site the needle well.

Luckily I had it to crash my high bp not ease pain so although it was frustrating that I'd had an intervention I didn't really want and wasn't even getting the benefits, it wasn't too bad. The odd bit was that topping up the epi would make my right arm go numb but i could feel large parts of my tummy and groin.

[Sawyer64]

I was told I had a "Spinal" Anaesthetic,which is apparently in another space to the "Epidural" Anaesthetic,better for CS apparently.

[Mintpurple]

a spinal would be no good for labour as its a 'one shot' injection in the back which wears off after a couple of hours - cant be topped up.

[PestoMonster]

They give you a spinal block if it's an elective caesarian, whereas for an emergency caesarian you get an epidural.

[PestoMonster]

Have had both!

[pipsy76]

I'm interested to watch this thread, as with ds1 it took 2 anaethetists 50 minutes to site my epidural, not fun! I'm due a c section in march and are already worried that perhaps will have problems again, don't want a ga.

[eilidhfi]

So is a spinal block easier to put in than an epi?

Pipsy, sounds like you'll be given a spinal block for a planned cs, hopefully that will go better for you. Has your midwife given you any advice?

[Mintpurple]

Pestomonster -
'They give you a spinal block if it's an elective caesarian, whereas for an emergency caesarian you get an epidural. '

Sorry to correct you but thats not accurate.

A spinal block usually works very quickly and so is often given for an emergency if no epi in situ.

An epidural takes longer to work and so is often given for electives, although can be topped up for an emergency if needed and has been working well.

Sometimes they use both as an epi can be used for pain relief after.

So, no definate answers, depends on the anaesthetist, the circumstances and the category of emergency.

[PestoMonster]

Sorry Mintpurple for the generalisation . That's what I was told when I had both of mine you see.

[BetsyBoop]

I would say it's more down to the anaesthetist both in what you get & how good they are at it.

I had an em c/s & an el c/s & had a spinal for both. (as other posters have said if you don't have an epi sited already it's fairly normal to have a spinal for an em c/s)

For my em c/s the spinal was sited in seconds, despite me having a contraction in the middle of things.

For my nice, calm el c/s the anaesthetist had about 10 goes (and I'm not kidding it was more if anything... ) and said "I think we might have a problem siting the spinal, I'm just going to call a colleague to help" - I was sitting there thinking "oh no, I'm going to end up with a GA...") when the second anaethetist arrived & again sited it in seconds....

However the procedure for setting up an epi & a spinal are similar

for an epi they use a large bore needle to site a tube in the epidural space (hence the name) which is then used to deliver the anaesthetic, which is why they can be topped up & the denseness of the block increased (if go from labour to needing em c/s for example)

for a spinal they use the large bore needle to deliver the anaesthetic direct to the epidural space - hence why they are a "one shot" thing & not used for labour.

[eilidhfi]

Thanks BetsyBoop, I think that's really what I wanted to know, if they can't get a needle in for an epi they can't get one in for a spinal block. Also good to know that sometimes it's the luck of the draw(although that isn't a good thing!)

[ElenorRigby]

No advice but sympathy, I have scoliosis and called a halt to the anaesthetist trying for a fifth time to site an epidural.

[BetsyBoop]

my post should have read

"for a spinal they use the small bore needle to deliver the anaesthetic direct to the subarachnoid space.

Note to self, check link between brain & fingers before posting

Once you have the date for your c/s I would ask for an appt with the anaesthetist who will be at your op. Yes back problems can be an issue, but it doesn't mean a spinal is totally contraindicated, especially as you say yours is only mild. I think they can sometimes do a dual block (i.e. effectively do each side separately) if there are back problems as a common problem is that it only works properly on one side.

[BetsyBoop]

right found the links I was after...

If you want more details, there is stuff here for epidurals and here for spinals

[eekamoose]

Sorry for slight hijack here, if any of you can answer this for me: if spinal blocks work so quickly, why could I not have had one of those rather than GA for my my emergency c/s? TIA. Its all very interesting.

[BetsyBoop]

yes spinals work more quickly than an epidural (which can take up to 30minutes to get to full effect)but they have to be administered and even it all goes perfectly smoothly it would be 5-10 minutes to complete (sterilising patient's back, getting patient into correct position, administering local anaestetic, positioning needle correctly, then drawing up & administering spinal anaesthetic, all this in between ongoing contractions and then waiting a few minutes for spinal to take effect, checking block is total with cold spray etc) whereas with a GA 30seconds & you are out cold

If they need to get bubs out really quickly then a GA is often the only choice.

[gasman]

Don't think you need me now as most of the questions have been answered but I couldn't resist this thread.

From the top:
Scoliosis can make epidurals both more difficult to site and partially ineffective.

In general if a junior anaesthetist (junior = not consultant) is having trouble doing a procedure they would call a consultant/ more senior person to see if they had any more success. V occasionally this isn't possible.

Sadly seniority doesn't always produce success - In the past month I 've seen two patients in whom we just couldn't get a functioning epidural (despite consultant involvement). Some units offer Remifentanil PCAs as an option for this eventuality.

As BB has said spinals and epidurals work by putting local anaesthetic into different places in your back. Having difficulty siting a epidural doesn't necessarily = difficulty siting a spinal on a future occasion. Because of the differences in where the local anaesthetic ends up scoliosis doesn't generally produce a unilateral (one sided block) after a spinal.

If you are worried then it would probably be useful both for you and the duty labour ward anaesthetist on the day you are in labour if you asked to be referred to the obstetric anaesthesia clinic now(even if your hospital doesn't have a formal clinic one of the consultants should be willing to see you).

BB has also explained why sometimes general anaesthesia is required in an emergency. Bascially it all depends on how 'distressed' your baby is. It is much quicker to give a GA than do a spinal (10 minutes vs. 20mins).

However if it looks like there is time then you should be offered a regional technique (spinal or epidural top up) as we know that people like to be awake to meet their baby.
Sometimes even people who have epidurals in for labour end up having GA sections owing to the pressing need to deliver their baby.

Hope this clears some issues up.

[pipsy76]

Thanks gasman. That was most informative and has cleared up some worrying questions for me, cheers!

[eekamoose]

Thanks also from me Betsy and Gasman. DD's delivery was very very urgent so I can now see why a spinal (even if it is faster than an epidural) couldn't have been an option for us.