Managing Complications in Pregnancy and Childbirth: - IAWG

Local anaesthesia for caesarean sectionP-9Note: When local anaesthesia is used, perform a midline incisionthat is about 4 cm longer than when general anaesthesia is used. APfannenstiel incision should not be used as it takes longer,requires more lignocaine and retraction is poorer.The anaesthetic effect can be expected to last about 60 minutes.Proceed with caesarean section (page P-43) keeping the following inmind:• Do not use abdominal packs. Use retractors as little as possibleand with a minimum of force.• Inject 30 mL of lignocaine solution beneath the uterovesicalperitoneum as far laterally as the round ligaments. No additionalanaesthetic is required. The peritoneum is sensitive to pain; themyometrium is not.• Inform the woman that she will feel some discomfort from tractionwhen the baby is delivered. This is usually no more than occursduring vaginal delivery.• Remove the placenta by controlled cord traction (page C-73).• Repair the uterus without removing it from the abdomen.• Additional local anaesthesia may be necessary to repair theabdominal wall.