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Although labor epidural analgesia is superior to meperidine for pain relief, labor is prolonged, uterine infection is increased, and the number of operative deliveries are increased. A two- to fourfold increased risk of cesarean delivery is associated with epidural treatment in both nulliparous and parous women.

General as well as regional anesthetic methods are equally acceptable for cesarean delivery in pregnancies complicated by severe preeclampsia if steps are taken to ensure a careful approach to either method.

Regional anesthesia is associated with fetal acidemia, occasionally severe, and has features of an acute respiratory type of acidemia. Fetal acidemia is less frequent with epidural anesthesia compared to subarachnoid techniques.

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NinetyPencil-point needles, such as the 25G Whitacre needle, are commonly used for spinal anaesthesia because their use is associated with a low incidence of post dural puncture headache (PDPH). 1.2 Recently, a new spinal needle (Atraucan| with a cutting point and a double bevel has been introduced (Figure). The use of the 26G Atraucan| needle is associated with easy insertion through the spinal ligaments, minimal trauma to the dural fibres, and a low incidence of PDPH. 3 In addition, rapid CSF backflow through the Atraucan| needle allows easy identification to the subarachnoid space. 3 However, insertion characteristics of the Atraucan needle and associated complications with its use have not been well established.

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SummaryOne hundred obstetric patients presenting for elective surgery who had refused regional anaesthesia were interviewed just prior to entering the operating room. In each case, the reason for refusing a regional technique was recorded. The most frequent reasons given were fear of backache (33%) and fear of the needle (28%). Anaesthetists should be aware of patients' concerns and be able to discuss the relevant issues.