Troubleshooting obstetric spinal anaesthesia at district hospital level

Abstract

Obstetric spinal anaesthesia is routinely used in South African district hospitals for caesarean sections, providing better maternal and neonatal outcomes  than general anaesthesia in appropriate patients. However, practitioners providing anaesthesia in this context are usually generalists who practise  anaesthesia infrequently and may be unfamiliar with dealing with complications of spinal anaesthesia or with conversion from spinal to general anaesthesia. This is compounded by challenges with infrastructure, shortages of equipment and sundries and a lack of context-sensitive guidelines and  support from specialised anaesthetic services for district hospitals. This continuous professional development (CPD) article aims to provide guidance with  respect to several key areas related to obstetric spinal anaesthesia, and to address common concerns and queries. We stress that good clinical practice is  essential to avoid predictable, common complications, and hence a thorough preoperative preparation is essential. We further discuss clinical indications  for preoperative blood testing, spinal needle choice, the use of isobaric bupivacaine, spinal hypotension, failed or partial spinal block and pain during the  caesarean section. Where possible, relevant local and international guidelines are referenced for further reading and guidance, and a link to a  presentation of this topic is provided.