CPD Articles

Troubleshooting obstetric spinal anaesthesia at district hospital level

David G. Bishop, Simon P.D.P. le Roux
South African Family Practice | Vol 64, No 1 : Part 4| a5529 | DOI: https://doi.org/10.4102/safp.v64i1.5529 | © 2022 David G. Bishop, Simon P.D.P. le Roux | This work is licensed under CC Attribution 4.0
Submitted: 14 March 2022 | Published: 28 July 2022

About the author(s)

David G. Bishop, Department of Anaesthesiology and Critical Care, Faculty of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
Simon P.D.P. le Roux, Global Surgery Division, Department of Surgery, Faculty of Health Science, University of Cape Town, Cape Town, South Africa


Obstetric spinal anaesthesia is routinely used in South African district hospitals for caesarean sections, providing better maternal and neonatal outcomes than general anaesthesia in appropriate patients. However, practitioners providing anaesthesia in this context are usually generalists who practise anaesthesia infrequently and may be unfamiliar with dealing with complications of spinal anaesthesia or with conversion from spinal to general anaesthesia. This is compounded by challenges with infrastructure, shortages of equipment and sundries and a lack of context-sensitive guidelines and support from specialised anaesthetic services for district hospitals. This continuous professional development (CPD) article aims to provide guidance with respect to several key areas related to obstetric spinal anaesthesia, and to address common concerns and queries. We stress that good clinical practice is essential to avoid predictable, common complications, and hence a thorough preoperative preparation is essential. We further discuss clinical indications for preoperative blood testing, spinal needle choice, the use of isobaric bupivacaine, spinal hypotension, failed or partial spinal block and pain during the caesarean section. Where possible, relevant local and international guidelines are referenced for further reading and guidance, and a link to a presentation of this topic is provided.


anaesthesia; resource-limited settings; emergency surgery; obstetric spinal anaesthesia; anaesthetic complications; caesarean section


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