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Regional anaesthetic

Anaesthesia is used to numb certain areas of your body or induce sleep before a medical procedure. When local anaesthetic is injected to numb your spinal nerves with a spinal or epidural, this may be called a regional anaesthetic (also known as a ‘neuraxial anaesthetic’). This type of anaesthetic allows you to be awake during a caesarean birth, as your lower body is numbed so you won’t feel any pain during the operation.


The types of regional anaesthetics used for caesarean birth are a spinal or an epidural or a combination of a spinal and epidural called a ‘combined spinal epidural’ (CSE).

Spinal anaesthetic

A spinal anaesthetic is the most commonly used form. It may be used in planned or emergency caesarean births. The nerves that carry feeling from your lower body are contained in a bag of fluid inside your backbone. The anaesthetist will inject local anaesthetic inside this bag of fluid, using a very fine needle. This method works fast, and only needs a small dose of anaesthetic.

Epidural anaesthetic

This is when a thin plastic tube or catheter is put next to the nerves in your backbone, and drugs to numb the nerves can be fed through the tube when needed. An epidural is often used to treat the pain of labour using weak local anaesthetic solutions. If you need a caesarean, the anaesthetist can top up the epidural by giving a stronger local anaesthetic solution. You would need a larger dose of local anaesthetic with an epidural than with a spinal, and it takes longer to work.


A combined spinal-epidural anaesthetic or CSE is a combination of the two. The spinal makes you numb quickly for the caesarean birth. The epidural can be used to give more anaesthetic if needed, and to give pain-relieving drugs after the caesarean.

In theatre, equipment will be attached to you to measure your blood pressure, heart rate, and the amount of oxygen in your blood. This won’t hurt. The anaesthetist will put a cannula (a thin plastic tube) into a vein in your hand or arm and will set up a drip to give you fluid through this. Then the anaesthetist will start the anaesthetic.

Receiving your anaesthetic

  • You will be asked to either sit, slouching over a pillow or lie on your side, curling your back.
  • The anaesthetist will spray your back with a cold sterilising solution and inject a local anaesthetic into your lower back to numb your skin.
  • From this point onwards, you should just feel pressure or pushing on your back. When the anaesthetic is being injected, you may feel tingling going down one leg, it is usually nothing to worry about but you should tell the anaesthetist if this happens. The procedure will take a few minutes but if it is difficult to find the right position for the needle, it may take longer.
  • Your bottom and legs will begin to feel warm and heavy or may start to tingle.
  • The anaesthetist will check the anaesthetic with a cold spray before the operation begins.
  • Sometimes your blood pressure can fall with the injection and this can make you feel sick. Please mention this as it can be treated very easily with medicines.

Insertion of a bladder catheter

While the anaesthetic is taking effect, a midwife will insert a small tube (a bladder catheter) into your bladder to keep it empty during the operation. This should not be uncomfortable. The bladder catheter will usually be removed once you are able to walk and at least 12 hours after the last “top-up dose” (a dose of spinal or epidural anaesthetic drugs given to maintain the effects of the anaesthetic). This means you won’t need to worry about being able to pass urine. 

During your caesarean birth, you may feel pulling and pressure, but you should not feel pain. Some women have described it as feeling like ‘someone doing the washing up inside my tummy’. The anaesthetist will talk to you while the operation is happening and can give you more pain relief if needed. Occasionally they may need to give you a general anaesthetic, but this is unusual.

  • Spinals and epidurals are usually better for you and your baby.
  • They let you and your partner share in the birth.
  • You will feel less sleepy afterwards.
  • They will let you feed and hold your baby as early as possible.
  • You will usually have good pain relief afterwards.
  • Your baby will usually be more alert when it is born.
  • Less post operative nausea and vomiting.

You may experience some of the following side effects:

  • Spinals and epidurals can lower your blood pressure, though this is easy to treat.
  • In general, they take longer to take effect, so it will take longer to get you ready for the operation than a general anaesthetic.
  • Occasionally, they may make you feel shaky.
  • Rarely, they do not work well enough, so the anaesthetist may need to give you a general anaesthetic.
  • You may have a tender area in the back where your needles goes in.
  • You may develop a post dural puncture headache.

The risks of a regional anaesthetic are shown in a table below. The information comes from published documents. The figures shown in the table are estimates and may be different in different hospitals.

Possible problem How common the problem is
Itching Common – about 1 in 3 to 10 people, depending on the drug and dose
Significant drop in blood pressure Spinal:
Common – about 1 in 5

Occasional – about 1 in 50
Epidural given during labour not effective enough to be topped up so another anaesthetic is needed for the caesarean birth

Anaesthetic not working well enough and more drugs are needed to help with pain during the operation

Regional anaesthetic not working well enough for caesarean birth and general anaesthetic is needed
Common – about 1 in 8 to 10

Occasional – about 1 in 20
Common – about 1 in 7

Occasional – about 1 in 50
Occasional – about 1 in 20
Severe headache Epidural:
Uncommon – about 1 in 100
Uncommon – about 1 in 500
Nerve damage
(for example, numb patch on a leg or foot, weakness of a leg)
Effects lasting less than six months:
Quite rare – about 1 in 1,000 to 2,000

Effects lasting more than six months:
Rare - about 1 in 24,000
Meningitis Very rare – about 1 in 100,000
Abscess (infection) in the spine at the site of the spinal or epidural

Haematoma (blood clot) in the spine at the site of the spinal or epidural

Abscess or haematoma causing severe injury, including paralysis (paraplegia)
Very rare – about 1 in 50,000

Very rare – about 1 in 168,000

Very rare – about 1 in 100,000
With an epidural:

A large amount of local anaesthetic being accidentally injected into a vein in the spine

A large amount of local anaesthetic being accidentally injected into spinal fluid, which may cause difficulty in breathing and, very rarely, unconsciousness

Very rare – about 1 in 100,000

Quite rare - about 1 in 2,000

As mentioned, these figures are estimates and may vary from hospital to hospital.

Please note: These questions and answers are by their nature quite general. We are afraid that the OAA cannot enter into discussions about nor answer enquiries about specific cases. If you have any questions, comments or complaints about your own care, you should take this up with the unit responsible. Please note that all hospitals have a Patient Advice and Liaison Service (PALS) who can help you if you are unsure how to go about this.