How is a spinal anaesthesia different from an epidural given during a C-section?

Here is all you need to know about these two procedures.

During a C-section, a mother is usually given a spinal anaesthesia as she is semi-conscious during the surgery. Many people wonder how this is different from the epidural given to mothers during a vaginal delivery to make it a smooth, pain-free experience. We spoke to Dr Mohamed Mansoor, Consultant, Anaesthesiologist, Motherhood Hospitals, to know the difference.

'Under most circumstances, undergoing a c-section via spinal anaesthesia or epidural anaesthesia (rather than general anaesthesia) is preferred since it involves less risk and has the advantage of allowing the patient to be awake during her baby's birth. In some cases, general anaesthesia may be the best option depending on patient's medical condition,' she says.

Difference between a spinal and an epidural for C-section

Spinal anaesthesia uses a very thin needle that is placed in the spine where the spinal fluid is located. This space is a few millimetres further inside from the epidural space in the spine. Medication is injected directly into the spinal fluid and the needle is then immediately withdrawn. The patient will begin to get numb within seconds and will be fully numb within a few minutes.

But epidural anaesthesia uses a thicker needle that is placed in the spine and guided towards the epidural space. A thin tube (catheter) is passed inside the needle into the epidural space and the needle is then taken out. The catheter remains in the spine (epidural space) and is taped to the skin. Medication is then injected into the epidural catheter to numb the lower part of the body. Since medication is not directly injected into the spinal fluid, more of it is needed to achieve the same level of numbness as a spinal. Full numbness is achieved within 20 minutes.

The pros of spinal versus epidural techniques

The pros of spinal anaesthesia are as follows:

• The probability of complete numbness may be slightly higher.
• Numbness can be more intense, so less pressure sensation can be felt during surgery.
• Quicker to get numb once the medication is in.
• Less medication is used to achieve numbness for the surgery.

The pros of epidural anaesthesia are as follows:

• More medication can be added through the epidural catheter if needed during surgery.
• The epidural catheter can be used to give pain medication into the spine after the surgery.

The disadvantages of spinal and epidural anaesthesia

Here are some of the disadvantages of spinal anaesthesia:

• Inability to give more medication via your spine once surgery proceeds.
• After surgery, pain medication is given via the IV rather than in the spine. Pain medicine given in the spine may work better.

Some of the disadvantages of epidural anaesthesia:

• There is slightly higher chance that some areas may not be completely numb.
• More medication is needed to achieve the same amount of numbness compared to the spinal method.
• Catheter taped to the back may cause skin irritation in the days following the c-section.

Ultimately, the decision to utilize the spinal or epidural route for a caesarean requires discussion with the anesthesiologist after considering all the medical options unique to the case.

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