UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Anesthesia for cesarean delivery

Authors
Heather Nixon, MD
Lisa Leffert, MD
Section Editor
David L Hepner, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Goals for anesthesia for cesarean delivery (CD) must include the comfort and safety of the parturient, and the well-being of the fetus and neonate. This topic will discuss the management of regional and general anesthesia for CD. Regional anesthesia techniques, adverse effects of neuraxial anesthesia, and neuraxial labor analgesia are reviewed separately. (See "Spinal anesthesia: Technique" and "Neuraxial analgesia for labor and delivery (including instrumented delivery)" and "Adverse effects of neuraxial analgesia and anesthesia for obstetrics".)

PREOPERATIVE ASSESSMENT

We agree with the American Society of Anesthesiologists (ASA) Practice Guidelines for Obstetric Anesthesia, which recommend that parturients undergoing cesarean delivery (CD) should have a focused history and physical examination by an anesthesia provider [1].

History and physical examination – Gestational history, past medical history, allergies, and anesthetic history should be reviewed. At a minimum, the physical exam should include an assessment of the vital signs, airway, cardiac and respiratory systems, and lower back. In the case of a scheduled and non-urgent, non-emergent cesarean delivery, adequate preoperative fasting should be verified. (See "Preoperative fasting guidelines", section on 'Pregnancy'.)

The preoperative assessment for emergent CD should be as comprehensive as time permits.

Antenatal anesthesia consultation – It is reasonable to schedule an antenatal consultation with an anesthesiologist for patients at risk of complications due to preexisting conditions, even if cesarean delivery is not planned. Each parturient should be viewed as a potential candidate for operative delivery during labor, possibly on an emergent basis. Some of the indications for antenatal anesthesia consultation are shown in a table (table 1).  

                                      

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Dec 06 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016; 124:270.
  2. Wong CA, McCarthy RJ, Fitzgerald PC, et al. Gastric emptying of water in obese pregnant women at term. Anesth Analg 2007; 105:751.
  3. Macfie AG, Magides AD, Richmond MN, Reilly CS. Gastric emptying in pregnancy. Br J Anaesth 1991; 67:54.
  4. Wong CA, Loffredi M, Ganchiff JN, et al. Gastric emptying of water in term pregnancy. Anesthesiology 2002; 96:1395.
  5. Hauptfleisch JJ, Payne KA. An oral sodium citrate-citric acid non-particulate buffer in humans. Br J Anaesth 1996; 77:642.
  6. Paranjothy S, Griffiths JD, Broughton HK, et al. Interventions at caesarean section for reducing the risk of aspiration pneumonitis. Cochrane Database Syst Rev 2010; :CD004943.
  7. Frölich MA, Burchfield DJ, Euliano TY, Caton D. A single dose of fentanyl and midazolam prior to Cesarean section have no adverse neonatal effects. Can J Anaesth 2006; 53:79.
  8. Mackeen AD, Packard RE, Ota E, et al. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev 2014; :CD009516.
  9. Coffman JC, Fiorini K, Ristev G, et al. Transversus abdominis plane and ilioinguinal/iliohypogastric blocks for cesarean delivery in a patient with type II spinal muscular atrophy. Int J Obstet Anesth 2016; 25:79.
  10. Mei W, Jin C, Feng L, et al. Bilateral ultrasound-guided transversus abdominis plane block combined with ilioinguinal-iliohypogastric nerve block for cesarean delivery anesthesia. Anesth Analg 2011; 113:134.
  11. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology 2005; 103:645.
  12. Ismail S, Huda A. An observational study of anaesthesia and surgical time in elective caesarean section: spinal compared with general anaesthesia. Int J Obstet Anesth 2009; 18:352.
  13. Hawkins JL, Chang J, Palmer SK, et al. Anesthesia-related maternal mortality in the United States: 1979-2002. Obstet Gynecol 2011; 117:69.
  14. Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2012; 10:CD004350.
  15. Heesen M, Hofmann T, Klöhr S, et al. Is general anaesthesia for caesarean section associated with postpartum haemorrhage? Systematic review and meta-analysis. Acta Anaesthesiol Scand 2013; 57:1092.
  16. Aksoy H, Aksoy Ü, Yücel B, et al. Blood loss in elective cesarean section: is there a difference related to the type of anesthesia? A randomized prospective study. J Turk Ger Gynecol Assoc 2015; 16:158.
  17. Hilt H, Gramm HJ, Link J. Changes in intracranial pressure associated with extradural anaesthesia. Br J Anaesth 1986; 58:676.
  18. Lee S, Lew E, Lim Y, Sia AT. Failure of augmentation of labor epidural analgesia for intrapartum cesarean delivery: a retrospective review. Anesth Analg 2009; 108:252.
  19. Ginosar Y, Mirikatani E, Drover DR, et al. ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery. Anesthesiology 2004; 100:676.
  20. Carvalho B, Collins J, Drover DR, et al. ED(50) and ED(95) of intrathecal bupivacaine in morbidly obese patients undergoing cesarean delivery. Anesthesiology 2011; 114:529.
  21. Lee Y, Balki M, Parkes R, Carvalho JC. Dose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weight women. Rev Bras Anestesiol 2009; 59:674.
  22. Heng Sia AT, Tan KH, Sng BL, et al. Hyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery. Anesth Analg 2015; 120:132.
  23. Sng BL, Siddiqui FJ, Leong WL, et al. Hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2016; 9:CD005143.
  24. McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine: a comparison to bupivacaine in volunteers. Anesthesiology 1999; 90:971.
  25. Gautier P, De Kock M, Huberty L, et al. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth 2003; 91:684.
  26. Maes S, Laubach M, Poelaert J. Randomised controlled trial of spinal anaesthesia with bupivacaine or 2-chloroprocaine during caesarean section. Acta Anaesthesiol Scand 2016; 60:642.
  27. Goldblum E, Atchabahian A. The use of 2-chloroprocaine for spinal anaesthesia. Acta Anaesthesiol Scand 2013; 57:545.
  28. Hejtmanek MR, Pollock JE. Chloroprocaine for spinal anesthesia: a retrospective analysis. Acta Anaesthesiol Scand 2011; 55:267.
  29. Philip J, Sharma SK, Gottumukkala VN, et al. Transient neurologic symptoms after spinal anesthesia with lidocaine in obstetric patients. Anesth Analg 2001; 92:405.
  30. Aouad MT, Siddik SS, Jalbout MI, Baraka AS. Does pregnancy protect against intrathecal lidocaine-induced transient neurologic symptoms? Anesth Analg 2001; 92:401.
  31. Dahl JB, Jeppesen IS, Jørgensen H, et al. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology 1999; 91:1919.
  32. Belzarena SD. Clinical effects of intrathecally administered fentanyl in patients undergoing cesarean section. Anesth Analg 1992; 74:653.
  33. Berger JS, Gonzalez A, Hopkins A, et al. Dose-response of intrathecal morphine when administered with intravenous ketorolac for post-cesarean analgesia: a two-center, prospective, randomized, blinded trial. Int J Obstet Anesth 2016; 28:3.
  34. Girgin NK, Gurbet A, Turker G, et al. Intrathecal morphine in anesthesia for cesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine. J Clin Anesth 2008; 20:180.
  35. Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia 2009; 64:643.
  36. Yang T, Breen TW, Archer D, Fick G. Comparison of 0.25 mg and 0.1 mg intrathecal morphine for analgesia after Cesarean section. Can J Anaesth 1999; 46:856.
  37. Cardoso MM, Carvalho JC, Amaro AR, et al. Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery. Anesth Analg 1998; 86:538.
  38. Crowgey TR, Dominguez JE, Peterson-Layne C, et al. A retrospective assessment of the incidence of respiratory depression after neuraxial morphine administration for postcesarean delivery analgesia. Anesth Analg 2013; 117:1368.
  39. Hess PE, Snowman CE, Wang J. Hypothermia after cesarean delivery and its reversal with lorazepam. Int J Obstet Anesth 2005; 14:279.
  40. Beatty NC, Arendt KW, Niesen AD, et al. Analgesia after Cesarean delivery: a retrospective comparison of intrathecal hydromorphone and morphine. J Clin Anesth 2013; 25:379.
  41. Sviggum HP, Arendt KW, Jacob AK, et al. Intrathecal Hydromorphone and Morphine for Postcesarean Delivery Analgesia: Determination of the ED90 Using a Sequential Allocation Biased-Coin Method. Anesth Analg 2016; 123:690.
  42. van Tuijl I, van Klei WA, van der Werff DB, Kalkman CJ. The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain and morphine requirements after Caesarean section: a randomized controlled trial. Br J Anaesth 2006; 97:365.
  43. Singh R, Gupta D, Jain A. The effect of addition of intrathecal clonidine to hyperbaric bupivacaine on postoperative pain after lower segment caesarean section: A randomized control trial. Saudi J Anaesth 2013; 7:283.
  44. Lavand'homme PM, Roelants F, Waterloos H, et al. An evaluation of the postoperative antihyperalgesic and analgesic effects of intrathecal clonidine administered during elective cesarean delivery. Anesth Analg 2008; 107:948.
  45. Khezri MB, Rezaei M, Delkhosh Reihany M, Haji Seid Javadi E. Comparison of postoperative analgesic effect of intrathecal clonidine and fentanyl added to bupivacaine in patients undergoing cesarean section: a prospective randomized double-blind study. Pain Res Treat 2014; 2014:513628.
  46. Cossu AP, De Giudici LM, Piras D, et al. A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia. Int J Obstet Anesth 2015; 24:237.
  47. Lam DT, Ngan Kee WD, Khaw KS. Extension of epidural blockade in labour for emergency Caesarean section using 2% lidocaine with epinephrine and fentanyl, with or without alkalinisation. Anaesthesia 2001; 56:790.
  48. Hillyard SG, Bate TE, Corcoran TB, et al. Extending epidural analgesia for emergency Caesarean section: a meta-analysis. Br J Anaesth 2011; 107:668.
  49. Bjørnestad E, Iversen OL, Raeder J. Similar onset time of 2-chloroprocaine and lidocaine + epinephrine for epidural anesthesia for elective Cesarean section. Acta Anaesthesiol Scand 2006; 50:358.
  50. Gaiser RR, Cheek TG, Adams HK, Gutsche BB. Epidural lidocaine for cesarean delivery of the distressed fetus. Int J Obstet Anesth 1998; 7:27.
  51. Karambelkar DJ, Ramanathan S. 2-Chloroprocaine antagonism of epidural morphine analgesia. Acta Anaesthesiol Scand 1997; 41:774.
  52. Toledo P, McCarthy RJ, Ebarvia MJ, et al. The interaction between epidural 2-chloroprocaine and morphine: a randomized controlled trial of the effect of drug administration timing on the efficacy of morphine analgesia. Anesth Analg 2009; 109:168.
  53. Lefrant JY, de La Coussaye JE, Ripart J, et al. The comparative electrophysiologic and hemodynamic effects of a large dose of ropivacaine and bupivacaine in anesthetized and ventilated piglets. Anesth Analg 2001; 93:1598.
  54. Schwoerer AP, Scheel H, Friederich P. A Comparative Analysis of Bupivacaine and Ropivacaine Effects on Human Cardiac SCN5A Channels. Anesth Analg 2015; 120:1226.
  55. Ngan Kee WD, Ng FF, Khaw KS, et al. Determination and comparison of graded dose-response curves for epidural bupivacaine and ropivacaine for analgesia in laboring nulliparous women. Anesthesiology 2010; 113:445.
  56. Santos AC, DeArmas PI. Systemic toxicity of levobupivacaine, bupivacaine, and ropivacaine during continuous intravenous infusion to nonpregnant and pregnant ewes. Anesthesiology 2001; 95:1256.
  57. Dony P, Dewinde V, Vanderick B, et al. The comparative toxicity of ropivacaine and bupivacaine at equipotent doses in rats. Anesth Analg 2000; 91:1489.
  58. Scott DB, Lee A, Fagan D, et al. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg 1989; 69:563.
  59. Feldman HS, Arthur GR, Covino BG. Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine, and lidocaine in the conscious dog. Anesth Analg 1989; 69:794.
  60. Hong JY, Jee YS, Jeong HJ, et al. Effects of epidural fentanyl on speed and quality of block for emergency cesarean section in extending continuous epidural labor analgesia using ropivacaine and fentanyl. J Korean Med Sci 2010; 25:287.
  61. Cherng CH, Wong CS, Ho ST. Epidural fentanyl speeds the onset of sensory block during epidural lidocaine anesthesia. Reg Anesth Pain Med 2001; 26:523.
  62. Vertommen JD, Van Aken H, Vandermeulen E, et al. Maternal and neonatal effects of adding epidural sufentanil to 0.5% bupivacaine for cesarean delivery. J Clin Anesth 1991; 3:371.
  63. Singh SI, Rehou S, Marmai KL, Jones PM. The efficacy of 2 doses of epidural morphine for postcesarean delivery analgesia: a randomized noninferiority trial. Anesth Analg 2013; 117:677.
  64. Vora KS, Shah VR, Patel B, et al. Postoperative analgesia with epidural opioids after cesarean section: Comparison of sufentanil, morphine and sufentanil-morphine combination. J Anaesthesiol Clin Pharmacol 2012; 28:491.
  65. Halpern SH, Arellano R, Preston R, et al. Epidural morphine vs hydromorphone in post-caesarean section patients. Can J Anaesth 1996; 43:595.
  66. Sakura S, Sumi M, Morimoto N, Saito Y. The addition of epinephrine increases intensity of sensory block during epidural anesthesia with lidocaine. Reg Anesth Pain Med 1999; 24:541.
  67. Thorén T, Holmström B, Rawal N, et al. Sequential combined spinal epidural block versus spinal block for cesarean section: effects on maternal hypotension and neurobehavioral function of the newborn. Anesth Analg 1994; 78:1087.
  68. Fan SZ, Susetio L, Wang YP, et al. Low dose of intrathecal hyperbaric bupivacaine combined with epidural lidocaine for cesarean section--a balance block technique. Anesth Analg 1994; 78:474.
  69. Choi DH, Ahn HJ, Kim JA. Combined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery. Int J Obstet Anesth 2006; 15:13.
  70. Cluver C, Novikova N, Hofmeyr GJ, Hall DR. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database Syst Rev 2013; :CD007623.
  71. Higuchi H, Takagi S, Zhang K, et al. Effect of lateral tilt angle on the volume of the abdominal aorta and inferior vena cava in pregnant and nonpregnant women determined by magnetic resonance imaging. Anesthesiology 2015; 122:286.
  72. Khaw KS, Wang CC, Ngan Kee WD, et al. Effects of high inspired oxygen fraction during elective caesarean section under spinal anaesthesia on maternal and fetal oxygenation and lipid peroxidation. Br J Anaesth 2002; 88:18.
  73. Chatmongkolchart S, Prathep S. Supplemental oxygen for caesarean section during regional anaesthesia. Cochrane Database Syst Rev 2016; 3:CD006161.
  74. Banerjee A, Stocche RM, Angle P, Halpern SH. Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. Can J Anaesth 2010; 57:24.
  75. Corke BC, Datta S, Ostheimer GW, et al. Spinal anaesthesia for Caesarean section. The influence of hypotension on neonatal outcome. Anaesthesia 1982; 37:658.
  76. Klöhr S, Roth R, Hofmann T, et al. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiol Scand 2010; 54:909.
  77. Ngan Kee WD, Khaw KS, Ng FF. Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section. Br J Anaesth 2004; 92:469.
  78. Tawfik MM, Hayes SM, Jacoub FY, et al. Comparison between colloid preload and crystalloid co-load in cesarean section under spinal anesthesia: a randomized controlled trial. Int J Obstet Anesth 2014; 23:317.
  79. Gunusen I, Karaman S, Ertugrul V, Firat V. Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Anaesth Intensive Care 2010; 38:647.
  80. Loubert C. Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development. Can J Anaesth 2012; 59:604.
  81. McDonald S, Fernando R, Ashpole K, Columb M. Maternal cardiac output changes after crystalloid or colloid coload following spinal anesthesia for elective cesarean delivery: a randomized controlled trial. Anesth Analg 2011; 113:803.
  82. Grylack LJ, Chu SS, Scanlon JW. Use of intravenous fluids before cesarean section: effects on perinatal glucose, insulin, and sodium homeostasis. Obstet Gynecol 1984; 63:654.
  83. Kenepp NB, Kumar S, Shelley WC, et al. Fetal and neonatal hazards of maternal hydration with 5% dextrose before caesarean section. Lancet 1982; 1:1150.
  84. Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg 2012; 114:377.
  85. Ngan Kee WD, Khaw KS, Tan PE, et al. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology 2009; 111:506.
  86. Smiley RM. Burden of proof. Anesthesiology 2009; 111:470.
  87. Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2002; 94:920.
  88. Ngan Kee WD, Khaw KS, Lau TK, et al. Randomised double-blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non-elective Caesarean section*. Anaesthesia 2008; 63:1319.
  89. Veeser M, Hofmann T, Roth R, et al. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand 2012; 56:810.
  90. Saravanan S, Kocarev M, Wilson RC, et al. Equivalent dose of ephedrine and phenylephrine in the prevention of post-spinal hypotension in Caesarean section. Br J Anaesth 2006; 96:95.
  91. Thomas DG, Robson SC, Redfern N, et al. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section. Br J Anaesth 1996; 76:61.
  92. Cooper DW, Carpenter M, Mowbray P, et al. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology 2002; 97:1582.
  93. Cooper DW, Sharma S, Orakkan P, Gurung S. Retrospective study of association between choice of vasopressor given during spinal anaesthesia for high-risk caesarean delivery and fetal pH. Int J Obstet Anesth 2010; 19:44.
  94. Ngan Kee WD, Khaw KS, Ng FF, Lee BB. Prophylactic phenylephrine infusion for preventing hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2004; 98:815.
  95. Allen TK, George RB, White WD, et al. A double-blind, placebo-controlled trial of four fixed rate infusion regimens of phenylephrine for hemodynamic support during spinal anesthesia for cesarean delivery. Anesth Analg 2010; 111:1221.
  96. Siddik-Sayyid SM, Taha SK, Kanazi GE, Aouad MT. A randomized controlled trial of variable rate phenylephrine infusion with rescue phenylephrine boluses versus rescue boluses alone on physician interventions during spinal anesthesia for elective cesarean delivery. Anesth Analg 2014; 118:611.
  97. Heesen M, Kölhr S, Rossaint R, Straube S. Prophylactic phenylephrine for caesarean section under spinal anaesthesia: systematic review and meta-analysis. Anaesthesia 2014; 69:143.
  98. Ngan Kee WD, Lee SW, Ng FF, et al. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology 2015; 122:736.
  99. Gao L, Zheng G, Han J, et al. Effects of prophylactic ondansetron on spinal anesthesia-induced hypotension: a meta-analysis. Int J Obstet Anesth 2015; 24:335.
  100. Heesen M, Klimek M, Hoeks SE, Rossaint R. Prevention of Spinal Anesthesia-Induced Hypotension During Cesarean Delivery by 5-Hydroxytryptamine-3 Receptor Antagonists: A Systematic Review and Meta-analysis and Meta-regression. Anesth Analg 2016; 123:977.
  101. D'Angelo R, Smiley RM, Riley ET, Segal S. Serious complications related to obstetric anesthesia: the serious complication repository project of the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2014; 120:1505.
  102. Jonsson M, Hanson U, Lidell C, Nordén-Lindeberg S. ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial. BJOG 2010; 117:76.
  103. May A. The Confidential Enquiries into Maternal Deaths 1997-1999: what can we learn? Int J Obstet Anesth 2002; 11:153.
  104. Langesaeter E, Rosseland LA, Stubhaug A. Haemodynamic effects of repeated doses of oxytocin during Caesarean delivery in healthy parturients. Br J Anaesth 2009; 103:260.
  105. Kovacheva VP, Soens MA, Tsen LC. A Randomized, Double-blinded Trial of a "Rule of Threes" Algorithm versus Continuous Infusion of Oxytocin during Elective Cesarean Delivery. Anesthesiology 2015; 123:92.
  106. Güngördük K, Asicioglu O, Celikkol O, et al. Use of additional oxytocin to reduce blood loss at elective caesarean section: A randomised control trial. Aust N Z J Obstet Gynaecol 2010; 50:36.
  107. Sheehan SR, Montgomery AA, Carey M, et al. Oxytocin bolus versus oxytocin bolus and infusion for control of blood loss at elective caesarean section: double blind, placebo controlled, randomised trial. BMJ 2011; 343:d4661.
  108. Balki M, Ronayne M, Davies S, et al. Minimum oxytocin dose requirement after cesarean delivery for labor arrest. Obstet Gynecol 2006; 107:45.
  109. George RB, McKeen D, Chaplin AC, McLeod L. Up-down determination of the ED(90) of oxytocin infusions for the prevention of postpartum uterine atony in parturients undergoing Cesarean delivery. Can J Anaesth 2010; 57:578.
  110. Lavoie A, McCarthy RJ, Wong CA. The ED90 of prophylactic oxytocin infusion after delivery of the placenta during cesarean delivery in laboring compared with nonlaboring women: an up-down sequential allocation dose-response study. Anesth Analg 2015; 121:159.
  111. Pandit JJ, Andrade J, Bogod DG, et al. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Br J Anaesth 2014; 113:549.
  112. Yoo KY, Lee JC, Yoon MH, et al. The effects of volatile anesthetics on spontaneous contractility of isolated human pregnant uterine muscle: a comparison among sevoflurane, desflurane, isoflurane, and halothane. Anesth Analg 2006; 103:443.
  113. Mhyre JM, Riesner MN, Polley LS, Naughton NN. A series of anesthesia-related maternal deaths in Michigan, 1985-2003. Anesthesiology 2007; 106:1096.
  114. Bonnet MP, Mignon A, Mazoit JX, et al. Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review. Eur J Pain 2010; 14:894.e1.
  115. Ambrose FP. A retrospective study of the effect of postoperative indomethacin rectal suppositories on the need for narcotic analgesia in patients who had a cesarean delivery while they were under regional anesthesia. Am J Obstet Gynecol 2001; 184:1544.
  116. Zeng AM, Nami NF, Wu CL, Murphy JD. The Analgesic Efficacy of Nonsteroidal Anti-inflammatory Agents (NSAIDs) in Patients Undergoing Cesarean Deliveries: A Meta-Analysis. Reg Anesth Pain Med 2016; 41:763.
  117. Valentine AR, Carvalho B, Lazo TA, Riley ET. Scheduled acetaminophen with as-needed opioids compared to as-needed acetaminophen plus opioids for post-cesarean pain management. Int J Obstet Anesth 2015; 24:210.
  118. Davis KM, Esposito MA, Meyer BA. Oral analgesia compared with intravenous patient-controlled analgesia for pain after cesarean delivery: a randomized controlled trial. Am J Obstet Gynecol 2006; 194:967.
  119. Kanazi GE, Aouad MT, Abdallah FW, et al. The analgesic efficacy of subarachnoid morphine in comparison with ultrasound-guided transversus abdominis plane block after cesarean delivery: a randomized controlled trial. Anesth Analg 2010; 111:475.
  120. Abdallah FW, Halpern SH, Margarido CB. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis. Br J Anaesth 2012; 109:679.
  121. McKeen DM, George RB, Boyd JC, et al. Transversus abdominis plane block does not improve early or late pain outcomes after Cesarean delivery: a randomized controlled trial. Can J Anaesth 2014; 61:631.
  122. Mishriky BM, George RB, Habib AS. Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis. Can J Anaesth 2012; 59:766.
  123. Weiss E, Jolly C, Dumoulin JL, et al. Convulsions in 2 patients after bilateral ultrasound-guided transversus abdominis plane blocks for cesarean analgesia. Reg Anesth Pain Med 2014; 39:248.
  124. Chandon M, Bonnet A, Burg Y, et al. Ultrasound-guided Transversus Abdominis plane block versus continuous wound infusion for post-caesarean analgesia: a randomized trial. PLoS One 2014; 9:e103971.