Complaint of the insufficient pain relief during a caesarean section
I was admitted to Oslo University Hospital, Ullevål labour&delivery (L&D) due to severe pre-eclampsia on 21.9.2020. The condition progressed but the progress was not recognized due to frequent changes in care providers. I was eventually admitted to high-dependency care and the baby was delivered by caesarean section. This adverse event report focuses on the failed pain relief during the caesarean section.
I had a functional epidural analgesia which was used during the labour induction. I agreed with the anaesthetist to use this epidural for the caesarean as well. The anaesthetist topped the system with local anaesthetic which did anesthetize the skin successfully. When the procedure started, I, however, started to feel escalating levels of pain. The operating team ignored this and carried on with the procedure, even though my son was not in immediate distress and it would have been possible to halt the operation and administer a general anesthesia.
Suddenly, I felt the strength to escape my limbs and heard a surprised and delighted comment ("Oj! Det funkade!" or something along this line). The pain kept escalating and I felt that I was suffocating but I could not signal my distress in any way, as my limbs felt paralyzed. I eventually had an out-of-body experience. All this was absolutely horrifying. At some point someone tried to push my newborn in my arms but I was too paralyzed to reach out to him.
I have discussed the incident with my partner, who confirms that I was in visible pain. He saw the anaesthetist to attach a syringe to my iv and quickly emptying it into the line immediately after the baby was delivered from the caesarean wound. He reports that I went limp and unresponsive after the injection. I have also discussed with Dr. 8, who suspected that the epidural failed to anesthetize the peritoneum and the surrounding tissues. This is a rare but known complication in caesareans performed under regional anaesthesia.
I want the following to be investigated:
When it was clear that I was in distress, why did the anaesthetist not halt the operation and administer a general anaesthesia?
Why do my medical notes fail to report that I was in pain during the operation?
If the epidural or spinal anaesthesia fails in a caesarean delivery, the correct course of action is to halt the operation and ask the mother whether she a) opts for general anaesthesia or b) wishes to carry on despite the pain. Injecting large doses of opiates without communicating is not a good pain relief strategy in such circumstances. It needs to be banned entirely to avoid my experience repeating in other patients.
Foreign MD
Ullevål sykehus, September 2020
