spinal or epidural for cs?

[PrincessScrumpy]

I'm having a cs in a couple of months and I cannot find any real details on the options of a spinal or epidural. The NHS baby book is useless unless you're having a natural birth with just a couple of paragraphs. Most of what I've learned comes from the internet but I'm struggling to tell the difference between the two. Can anyone advise?

[reikizen]

tbh, it is not a choice you can make! The anaesthetist will make a decision based on your anatomy (as both are placed in different areas of your spinal column) and the situation at the time. Sometimes an epidural inadvertently turns into a spinal, and sometimes an epidural is not possible so a spinal is performed. If both of these fail, or you are feeling pain during the operation, a general anaesthetic will be performed. A spinal acts quicker but does not last as long. The pain relief is more complete and it is usually the first choice (ime) for a section. It will take longer to regain sensation in your lower half than an epidural. However, all anaesthetists would be happy to offer an expert opinion and you will have an appointment with an anaesthetist before your section so prepare your questions for then. Good luck.

[Whyriskit]

I've had both but have had 2 EMCS so my experience may be different from yours.
The first was a spinal, took a bit of time to take effect and a long time for them to be able to get it in (I'd already had an epidural but they couldn't put it in the same site). Really couldn't feel anything at all, took about 10 hours to wear off.
The second was an epidural top up and I felt a bit more "rummaging" as they removed DS2.
I don't think there really is a difference tbh! Have you asked your MW?

[laluna]

It will be a spinal. They are very similar but the epidural is inserted into the epidural space and a very fine cannula is left in place and used to adiminster/top up with the local anaesthetic/narcotic mix. The spinal differs as the anaesthetic is injected directly into the sub arachnoid space as a bolus, one off dose and tends to be shorter acting. The procedure for siting them is very similar.

[reikizen]

a midwife is not an expert on anaesthetic techniques, speak to the people who do it for a living when you go for your anaesthetic assessment.

[laluna]

No we are not experts but have some understanding of the basics!

[PrincessScrumpy]

Thank you.

I'm seeing my consultant every fortnight so haven't really seen a mw for ages - mind you, mine was a bit wet. My pg is "high risk" as it's ID twins.

[reikizen]

Laluna, as a midwife, I am aware of the basics but I thought the OP could benefit from a conversation with the professional who will be performing the procedure. I am referring her to the most appropriate member of the team as this is out of my 'sphere of practice'. Sounds like one of my assignments from when I was a student.

[travispickles]

I had an epidural and still felt pain so I would go for a spinal.

[mintpurple]

I think different places use slightly different techniques and in the hospital where I work, its normally a spinal epidural that is used (for an elective c/s)
So basically they do a spinal and insert the epidural catheter through the same hollow needle. ( I can explain in more detail but not really much point).

The spinal gives fairly fast analgesia and the epidural is there to give pain relief after if needed and also most people have a bit of diamorphine into the epidural which gives fairly good pain relief after for 12-24 hours.

But you really need to speak to the anaesthetist to see what they do at your hospital.

[vj32]

I had a spinal for my emergency cs- which was an injection into my spine that started working in seconds - the doctors and nurses had to push me over to make me lie down because I didn't realise how quickly I would use the use of my legs and otherwise I could have fallen off the table.

I was told it would start to wear off in 2 hours. I wasn't totally aware of time at this point(!) but I think that was right. I had a catheter but this was able to be removed 12 hours later. I really didn't want an epidural as really disliked the idea of a tube in my spine. But in the circumstances I would happily have gone along with whatever the doctors recommended.

[BagofHolly]

Ive had 2 sections and I've had both. My anaesthetist said that an epidural is usually preferable as they can keep you topped up for as long as necessary. I was on heparin with both pregnancies and had taken the last dose too close to the operation the first time and had to have a spinal instead as it's a one off hit into the spine, rather than keeping it open so there's less chance of bleeding. Second time I had an epidural, which was handy as I had a big post partum haemorrhage straight afterwards and they were able to top me up quickly so I didn't feel the terrible rummaging which was taking place down below.

[gasman]

OK. Anaesthesia for Elective LSCS 101

There are 4 options:

1. Spinal (probably 1st choice)
   One off injection at bottom of your back using a very small needle. Local anaesthetic /opiate is placed directly into the fluid around your spinal cord.
   The block should come on really quickly (ie within 5 mins, but can exceptionally take longer) and wears off (from operative conditions, not from getting out of bed condition) in about 2 hours.
   The block is typically more dense but you will experience some sensation
   
   
2. Epidural
   A very thin plastic tube is placed into the epidural space (which is the space between the membrane which holds your spinal fluid in place and the ligaments in your back. Drugs are then put down the plastic tubing. These can be added to during the operation .
   The block takes longer to work - usually > 20mins for a new epidural and slightly less than that if you have had it running in labour. As you can top it up it never runs out.
   The block is less dense and sometimes we struggle to get an epidural to work adequately for an operation
   
   
3. Combined Spinal Epidural (CSE).
   Has fluctuating levels of popularity throughout the country eg. where I trained it was used a lot, where I work now it is barely used.
   Involves the needle being put into your back as if to insert an epidural, but prior to the plastic tubing being threaded a much thinner needle is put down the epidural needle and local anaesthetic is injected into the spinal fluid. Then the epidural catheter (plastic tubing) is passed and it can be topped up in the same was a regular epidural so you get the benefit of a quick acting spinal and the advantage of being able to add more drugs if the operation takes ages.
   It does carry slightly different risks to either of the other two.
   
   
4. General Anaesthesia
   not often performed for an elective operation as we know that 1) it is safer for the mother / baby to have a regional technique and 2) most woman want to see their baby born.
   Some people have preexisting condidtion that mean a GA is the only safe option though.
   
   There is more information on here:
   www.oaa-anaes.ac.uk/content.asp?ContentID=83
   
   I'll try to pop back in the next day or two to answer any questions that people may have (and there are a few other anaesthetists that use the site so one of them might be along too).

[gailforce1]

Sorry to hijack the thread but GASMAN I remember you were expecting recently and I have missed your birth announcement! Did you have a boy or girl?

[gasman]

Not me. My interest in reproduction at this point in my life is purely professional.

[gailforce1]

Ooooops! Wonder who I am thinking of? I was sure aMN anaesthetist was due?

[ImBrian]

When I had my dd they took me down to theatre for a ventouse but thought I might need a emergency section. I had an epidural in and they gave a spinal in the same tube.

[PrincessScrumpy]

Thank you so much - I think I'll quiz my consultant next week as I'll be 24 weeks - it's seemed a bit too early to ask about the birth up until now. DH will be at that appointment too so he can help me remember.

[steffanny]

I hade a section with an epidural and felt it and had to have a general in the middle of the op.

I had my second one with a spinal and felt nothing so IMO I would go for a spinal every time.

[ShowOfHands]

I think you can express a preference but there's no way of knowing if it's something they will/can take into account depending upon myriad factors.

I had a spinal for an emcs, I was put onto the ward a couple of hours post section with full movement. I cared for dd independently and was ready for discharge 12hrs post op. The other women on the ward who'd had epidurals still had them in situ for pain relief and therefore were in bed and nowhere near being up and about at the point that I was signing the papers and going home. This for me was a major pro to the spinal over the epidural. It's a one off injection and once it had worn off it was forgotten about.

[gasman]

ImBrian - you can't have had a spinal via an epidural catheter unless it had moved in your back as the local anaesthetic goes into a different place. It is possible that they gave you stronger local anaesthetic to convert your pain relieving epidural into an anaesthetic one.

I would caution all of you, in the same way that I caution my own family, that the best anaesthetic for an operation is the one that the scheduled anaesthetist fees comfortable to give you. We all have our own idiosyncricies and what one of my colleagues can get to work beautifully for a particular operation sometimes doesn't work for me as my standard technique for that operation might be totally different. I hope that makes sense.

[ImBrian]

They just said it was a spinal, so assumed it was a spinal block

[ShowOfHands]

gasman, I know what you mean. I was always told that regardless of preference, the anaesthetic you receive is always best when delivered from an anaesthetist who is happy administering it and likewise the stitches or staples that close you from a surgeon who is au fait with them. I had a spinal block and a running stitch and it was absolutely the best thing for me, the woman next to me an epidural and staples and ditto. Different operating theatre, different staff on, same satisfactory outcome.