Journal of Anaesthesiology Clinical Pharmacology

LETTER TO EDITOR
Year
: 2014  |  Volume : 30  |  Issue : 4  |  Page : 578--579

Cesarean section under local anesthesia: A step forward or backward?


Bablesh Mahawar, Neha Baduni, Pooja Bansal 
 Department of Anaesthesiology, ESI Hospital, New Delhi, India

Correspondence Address:
Neha Baduni
ESI Hospital, Rohini, New Delhi
India




How to cite this article:
Mahawar B, Baduni N, Bansal P. Cesarean section under local anesthesia: A step forward or backward? .J Anaesthesiol Clin Pharmacol 2014;30:578-579


How to cite this URL:
Mahawar B, Baduni N, Bansal P. Cesarean section under local anesthesia: A step forward or backward? . J Anaesthesiol Clin Pharmacol [serial online] 2014 [cited 2021 May 17 ];30:578-579
Available from: https://www.joacp.org/text.asp?2014/30/4/578/142878


Full Text

Sir,

Cesarean sections are most commonly performed under spinal anesthesia. However, there are many cases where local anesthesia has been highly useful and even life saving such as patients who are morbidly obese, have difficult airway or severe coagulopathy. [1] We are highlighting the successful conduct of Cesarean section under local anesthesia in a 26-year old, ASA III woman, with previous one lower segment Cesarean section (LSCS). She presented to casualty with scar tenderness and fetal distress (fetal heart rate between 90 and 100 per minute), hence was scheduled fo an emergency LSCS.

The patient gave history of weakness of all limbs for the past 2 years, associated with pain in lower back and both the hip, knee, shoulder and elbow joints. On examination, she was severely malnourished and pale. Motor power was 1/5 in all the four limbs. She had no investigations available with her. Hemoglobin by pin prick was 6.2 gm/dl.

The decision to give a subarachnoid block, without completely investigating the patient, was questionable. We could not give general anesthesia as there was no ventilator or ICU back up at that time. We decided to get this life-saving surgery done under local anesthesia along with Entonox.

Informed, high-risk consent was taken and the patient was shifted to the operating room. The surgeons cleaned and draped her abdomen and Entonox was administered through a face mask. They gave local infiltration with 8 cc of 0.5% bupivacaine in the skin and subcutaneous tissue and started the surgery keeping in mind that they had to use no retractors or packs, had to be very gentle and were to avoid any sudden movement. After 5 minutes, a male baby of 1.9 kg with Apgar of 8, 9 was delivered. The patient was given 20 μg of fentanyl intravenously and the uterine incision was closed.

Another 6 cc of 0.5% of bupivacaine was infiltrated in the rectus sheath, subcutaneous tissue and skin, along with 10 μg of fentanyl intravenously, and her abdomen was closed. Her surgery lasted around 45 minutes and her hemodynamic parameters remained stable. She was transfused with two units of packed cells postoperatively.

An orthopedic and physician referral was taken postoperatively and she was diagnosed to be suffering from myopathy due to severe oestomalacia. Her S. Calcium was-5.2 mg/dl, ionised Calcium was 2.8 mg/dl, S. Albumin was-2.2 g/dl 2.8, ALP was-688 I/L, Hb-6.8 g/dl, S. Fe-25 μg/dl, S ferritin-12.1 μg/L, Vit D 3 -10.8 ng/ml. MRI of whole spine revealed biconcave shaped vertebra with pseudofractures (looser's zone), indicative of severe oestomalacia.

She was administered vitamin D 3 intramuscularly as well as orally and oral calcium for 6 weeks, along with oral iron. When she came for follow-up after 12 weeks, she was walking normally and was able to do her household chores though had developed an incisional hernia.

Local anesthesia for LSCS causes loss of pain sensation in selected areas only, with minimal disturbances of other systems, especially the cardiovascular and respiratory system. [2] Rooney et al. noted the incidence of complications after using local anesthesia for LSCS, including fetal demise, was significantly lower. [3] Infact, majority of the mothers opted for local anesthesia for a repeat LSCS.

Although we do not advocate the use of local anesthesia for all Cesarean sections, it can be safely used in high-risk patients where sub-arachnoid block or general anesthesia can be associated with complications. There is no evidence that Cesarean section under local anesthesia has an increased incidence of mortality than any other form of anesthesia.

References

1Patil S, Sinha P, Krishnan S. Successful delivery in a morbidly obese patient after failed intubation and regional technique. Br J Anaesth 2007;99:919-20.
2Nandgopal M. Local anesthesia for caesarean section. Tech Reg Anesth Pain Manag 2001;5:30-5.
3Ranney B, Stanage WF. Advantages of local anesthesia for caesarean section. Obstet Gynecol 1975;45:163-7.