Regional compared with general anaesthesia for caesarean section.
Caesarean section is when a baby is born through an incision in the mother's abdomen and uterine wall. This requires effective anaesthesia which can be regional (epidural or spinal) or a general anaesthetic. With regional epidural anaesthesia, the anaesthetic is infused into the space around the mother's spinal column, whilst with regional spinal anaesthesia, the drug is injected as a single dose into the mother's spinal column. With the two types of regional anaesthesia, the mother is awake for the birth but numbed from the waist down. With general anaesthesia, the mother is unconscious for the birth with the anaesthetic affecting her whole body. As well as women having a view as to whether they might wish to be awake or asleep for the caesarean birth, it is important to know the balance of the benefits and adverse effects of these different types of anaesthesia. The review of trials sought to assess these benefits and harms, and identified sixteen randomised controlled trials involving 1586 women. There were some differences which favoured general anaesthesia, for example, less nausea and vomiting. There were also some differences which favoured regional anaesthesia, for example, less blood loss and less shivering. The evidence on the differences in pain was difficult to evaluate. There were not enough participants to assess the very rare outcome of mortality for the mother, which may be an important aspect. None of the trials addressed important outcomes for women like recovery times, effects on breastfeeding, effects on the mother-child relationship and length of time before mother feels well enough to care for her baby. As there is insufficient evidence on benefits and adverse effects, women are most likely to choose anaesthesia for caesarean section, depending on whether they wish to be awake or asleep for the birth.