Managing Complications in Pregnancy and Childbirth: - IAWG

P-8 Local anaesthesia for caesarean sectionTalk to the woman and reassure her throughout the procedure.• Using a 10 cm needle, infiltrate one band of skin and subcutaneoustissue on either side of the proposed incision, two finger breadthsapart (Fig P-4).Note: Aspirate (pull back on the plunger) to be sure that no vesselhas been penetrated. If blood is returned in the syringe withaspiration, remove the needle. Recheck the position carefully andtry again. Never inject if blood is aspirated. The woman can sufferconvulsions and death if IV injection of lignocaine occurs.FIGURE P-4Infiltration of skin and subcutaneous tissue with localanaesthesia for caesarean section• Raise a long wheal of lignocaine solution 3–4 cm on either side ofthe midline from the symphysis pubis to a point 5 cm above theumbilicus.• Infiltrate the lignocaine solution down through the layers of theabdominal wall. The needle should remain almost parallel to theskin. Take care not to pierce the peritoneum and insert the needleinto the uterus, as the abdominal wall is very thin at term.• At the conclusion of the set of injections, wait 2 minutes and thenpinch the incision site with forceps. If the woman feels the pinch,wait 2 more minutes and then retest.Anaesthetize early to provide sufficient time for effect.