Csection spinal wore off

[FirstTimeBumps]

Hoping someone might have similar experience or there's an anesthetist lurking about here.

My first csection was an emergency one and the spinal appeared to wear off. Up until today I wasn't sure if it was potentially subconscious and anxiety related even though I had practically skipped into the theatre.

Today I had a consultant appointment for an elective section for #2 due in a month and on checking my notes she said they had given me alfentanil which is why I can't remember anything and had repeatedly offered to put me under general. She said it could be down to misplacement of the spinal although it worked initially, or that I have a fast metabolism for the anesthesia used in the spinal.

It's now down in my notes for the anesthetist this time, but I'm just wondering how they will work around it. Can I expect the nice calm csection everyone talks about electives being or should I brace myself for a rocky ride again?

Retired anaesthetist here, OP. Did you feel pain during the surgery, or just pressure and touch? Because a spinal only blocks pain - you will still feel some quite forceful “rummaging” and pushing on your abdomen as they deliver the baby, even with a fully working spinal.
It’s possible that the needle slipped back slightly from the intrathecal space to the epidural space during injection, so only half the dose got to the right place.
Warn your anaesthetist that this happened last time, and get them to check you have a solid motor block - unable to move your legs- before starting surgery.
There is always the possibility to convert to general anaesthetic on the table if you start feeling pain halfway through. Alternatively you could discuss opting for a GA from the start.

Thank you @babdoc. There was definitely no movement, legs completely dead (at least initially up to where I remembered). It was definitely pain not just pressure, although strangely not as I'd expect it to be for someone slicing you open. I was offered GA several times during the section last time and declined, and am keen to avoid it this time too. The consultant has put it in my pathway notes so they'll know in advance. I'm just wondering if they might offer a combined spinal/epidural instead. The one bonus last time was how quick I was up on my feet though.

Sounds like a combined spinal epidural is an excellent idea and lots of people do it for second sections anyway or if any difficult history previously (amongst other things). Good to have it in your notes and whichever anaesthetist you have on the day will be able to talk it through with you too! (Anaesthetist who does a lot of obstetrics!)

A combined spinal/epidural carries the opposite risk - of local anaesthetic solution spreading through the puncture in the dura, from the epidural space into the CSF in your intrathecal space and taking the block too high, making it difficult for you to breathe.
It needs a higher volume of local to produce anaesthesia with an epidural as opposed to a spinal, (15 to 20 mls versus 2 to 3mls) hence the problem if some of the extra amount travels through.
I have occasionally had to ventilate a patient after a junior has administered an epidural top up via a CSE during surgery, though thankfully not a section.
Have a chat with your anaesthetist on the day, and they’ll make a management plan with you that covers the possibilities and takes account of your preferences.

Thank you both

Same happened to me OP.
I initially had an epidural but it was never working properly (was more on one side) and then got the spinal when it became apparent I needed the emcs. All fine at the start but the op took longer than expected (unknown source of bleeding) and spinal was wearing off at the end. I too was offered GA and declined, just told them to bloody hurry up! I agree I wasn't in as much pain as you might expect but presumably that was the adrenaline and the fact the spinal was partially working.

@Lisa78Lemon it was odd it felt more like a crushing pain than sharp slicing which you would imagine. I think I'm so against a general because what if I can still feel it then but can't indicate my problem. My other half mentioned he's never had a problem with a general and I was like what happens if you have but you just can't remember it!

I had the same experience OP, I had to have further surgery post section and the section had been long and complex as it was. It was a very strange experience, and more than anything it's the panic that has stayed with me - realising I was starting to feel pain and knowing that although it was bearable in that moment, it was about to get excruciating. Brr. Thankfully it didn't, they gave me something else and I spent the next couple of hours in and out of consciousness and puking on my own face! Anyway, all that is to say I'm sorry it happened to you and please do consider accessing some kind of counselling.

@FirstTimeBumps the same thing happened to me during my first emergency C-section - the pain was so bad that I was on gas and air while they were stitching me up. They offered me a general anaesthetic many times but I refused as I didn't want my husband to leave the room. Fast forward 5 years and I had an ELCS and it was amazing. I spoke to the anaesthesist before hand and explained my concerns (on the morning of the op), when in theatre he gave me a high dose and triple checked several times with the cold spray that everything was numb and he kept it well topped up throughout. I think in my case as my first birth was a proper emergency (baby's life was at risk) it was just rushed and the placement wasn't good. Second time round I couldn't feel anything for a long time - was able to walk about 6 hours after the op. Thankfully everyone is ok.

@peachgreen I was fortunately out of it too on what I've since found out was alfentanil so remember nothing either. I don't feel like it's really affected me, you always hear about birth trauma but I don't feel like I have that at all and even though unpleasant I have no negative feelings towards it. I think I practically just want to prepare for what's to come and know what to expect this time.

@thisyeargoodyear I too had the gas and air, and thought that was what sent me went but as I couldn't remember anything at all thought they must have pumped me full of something else which I found out was the alfentanil yesterday. I'm glad to hear your second was better. That's what I'm hoping for too, although first wasn't a proper emergency and they did take their time. Did they give you a different type of anesthesia the second time round as I thought the spinal was given then that was it. I think the downfall is the lack of mobility afterwards if it works properly. I was up 3 hours after surgery and would have been up sooner had they removed all the things tethering me down 🤣 they waited for visitors to go first.

@FirstTimeBumps I think I did get something different second time round but it's all a bit of a blur to be honest as I just wanted baby here so didn't take much in

Try and not worry too much, electives are so much better and nothing is rushed. Good luck to you when the time comes.