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Re: C/S Under Local Anesthesia From: Braun, R. Daniel (rbraun@iupui.edu) Sun Feb 6 20:07:21 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Braun, R. Daniel: "Re: C/S Under Local Anesthesia" Previous message: Paul Prior MD: "Re: Fetal Lung Maturity Question" Maybe in reply to: Gerald P. Rodriguez: "C/S Under Local Anesthesia" Next in thread: Braun, R. Daniel: "Re: C/S Under Local Anesthesia" I concur with Douglas. Dan -----Original Message----- From: Douglas J. Krell MD To: Multiple recipients of list OB-GYN-L Sent: 2/6/00 1:18 PM Subject: Re: C/S Under Local Anesthesia I've done 2 of these at PHS hospitals when no anesthesia was available. Gil Web is wasting time, in my opinion. Just inject 1% xylocaine subQ in a straight shot umbilicus to pubis. Do the same to the fascia. Simply squirt xylocaine over the surface of the lower uterine segment and any other peritoneal surface you see. You get instant peritoneal anesthesia to make a small bladder flap, incise the uterus and deliver the baby. Start pitocin as the baby is being delivered and the placenta will be squeezed out by the contracting uterus with minimal blood loss as you are waiting for anesthesiology to arrive. Douglas Krell MD "Jane Helwig, MD" wrote: > Gerald, > > Here are Gil Webb's directions (I may have posted them last year). I > agree with Dan and Joe--not an experience I want to repeat. As we have > discussed, taking the time to get reasonably good local anesthesia > negates the purpose of doing the procedure, which is to get the baby out > ASAP. Agree with waiting for anesthesia before repairing the uterus > although do deliver the placenta to reduce blood loss. (I know El is > going to tell us just to put in a quick spinal, which I don't have > privileges for.) > > May no one ever need these instructions... > > Cesarean section under local -- Gil Webb, MD > lecture at California Pacific Medical Center 2/27/95 > > 1. Use 1/2% lidocaine > 2. Keep dosage under 100 cc > 3. Only works with vertical incision > 4. Remember the nerves go up and out over the abd wall > 5. Make three wheals at 3 points in midline, 10 cc each, injecting as a > fan. > 6. Put 2cc in each little injection in fascia--don't stick the uterus. > 7. Inject q1-1/2 to 2cm down each side of the midline > 8. Inject about 5cc at the pubic tubercle > 9. Inject the peritoneum, a cc or so down each side q1-2 cm > 10. Use hands as retractors, then inject under the anterior abd wall, > 5cc --aspirate--, can then place retractors. > 11. No need to inject uterus. > 12. Make incision in uterus long enough. > 13. Don't deliver the uterus. > > At Sat, 5 Feb 2000, Gerald P. Rodriguez wrote: > > > >Has anyone seen a recent protocol for doing a C/S under local anesthesia? Given the recent VBAC issues recently, I failed to see local anesthesia discussed but I could have missed this, since I am now traveling more after semi-retiring in September. > > > > -- > Jane Helwig, MD, FACOG > Private practice > Nassawadox, VA Next message: Braun, R. Daniel: "Re: C/S Under Local Anesthesia" Previous message: Paul Prior MD: "Re: Fetal Lung Maturity Question" Maybe in reply to: Gerald P. Rodriguez: "C/S Under Local Anesthesia" Next in thread: Braun, R. Daniel: "Re: C/S Under Local Anesthesia"

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