Expert: Ronald Levy, M.D. - 4/4/2011

Question
I have had an epidural/spinal block combination for both my previous C-sections - only the second one was planned in advance and they still used an epidural/spinal combo. However I'm going to a new hospital this time and I'm being told that for scheduled C's they only do spinal anesthesia. My concern is that I will not be able breathe - on my second C, I felt like the medicine was in my lungs and I started hyperventilating and they had to put a pillow under my head b/c I felt I couldn't lie flat on my back without suffocating - but I still had to deal with the feeling constantly during the C. Did they put too much in or put it in too high? How can I avoid this in the future? Secondly, without the epidural I will not be managing my own pain afterwards like I did in the past with a self-pump. I have been told that they can shoot something called duramorph? into the spinal that will last for 24hrs and help with the pain BUT that it makes you nauseated. I also know they can shoot some anti-nausea in the spinal but that it wears off at 2 hours. How can I avoid post-op pain and nausea? I'd like to come in with a game plan b/c a person generally gets about 3 minutes with the anesthesiologist before surgery. I want to enjoy the birth of my 3rd child and not worry about pain and breathing!

Answer
The c-sections were done with the spinal, the epidural was for the postop pain. As for most places, if the c-section is scheduled, they generally only do a spinal. The spinal may have been a little high last time but that doesn't mean anything for this time. The spinal is far more reliable than an epidural. As for post-op pain, the duramorph lasts up to 24 hours and can cause some itching (but rarely nausea). The nausea is treated by IV (not in the spinal) and it lasts 3-4 hours and can be redosed if necessary.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston