Failure of regional blockade for caesarean section.

This four-year retrospective study examined the quality of regional blockade for caesarean section. For patients having spinal anaesthesia, data were available on requirement for analgesic supplementation or conversion to general anaesthesia. In those having epidural anaesthesia, data were available only for conversion to general anaesthesia. A total of 1644 patients due to have caesarean section under spinal anaesthesia were studied and of these, 48 (2.9%) required general anaesthesia at some stage. Of the 1610 patients in whom a caesarean section was started under spinal, 12 (0.75%) received general anaesthesia while 175 (10.9%) required some analgesic supplementation. Of the 827 patients in whom epidural analgesia was in progress for labour and a decision was made to proceed to caesarean section, a total of 87 patients (10.5%) needed general anaesthesia. Of those (763) in whom caesarean section was started under epidural, only 17 (2.2%) were given general anaesthesia because of intra-operative pain. Although these results may fall short of best practice, they may enable the anaesthetist to give more accurate information to patients so that better informed consent can be obtained.