Trends in regional anaesthesia for caesarean section in a Nigerian tertiary health centre.

BACKGROUND: Most caesarean sections were previously performed under general anaesthesia but there has been an increasing trend worldwide in the use of regional anaesthesia as the preferred method of anaesthesia for caesarean delivery.

OBJECTIVE: To evaluate the trend of practice of regional anaesthesia for caesarean section in a tertiary hospital in South-western part of Nigeria.

METHODS: The obstetric operating room records at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria were reviewed for a twenty-year period: January 1986 to December 2005. The anaesthetic techniques for caesarean section and the level of training of the attending anaesthetist were noted.

RESULTS: A total of 1,785 patients were delivered by caesarean section during the twenty-year period . Most patients [1578(88.4%)] had caesarean section under general anaesthesia while 207(11.6%) had regional anaesthesia. Subarachnoid block accounted for 89(5%) of the patients and 118(6.6%) had the caesarean section under epidural block. One hundred and ten (21.5%) of the regional techniques were in the first quarter of the 20-year period. This figure fell to eight (2%) in the second quarter; zero in the third quarter and rose to 82(13.7%) in the last quarter demonstrating an increasing trend of regional technique for caesarean section. Majority of the epidural blocks were conducted by nurse-anaesthetists while the subarachnoid blocks were administered by anaesthetists.

CONCLUSION: There is an overall low practice or usage of regional anaesthetic for caesarean section. A trend towards increasing administration of regional technique for caesarean section is demonstrated. A dedicated period for hand on the job workshop in regional blocks may enhance early and prompt acquisition of relevant skills in regional anaesthesia for caesarean delivery.