Advertisement

Neurological complications in obstetric regional anaesthesia

      Abstract

      Central neuraxial blocks are the commonest procedures performed in obstetric anaesthesia. Most post-partum neurological complications are obstetric palsies caused by the process of normal labour itself. However, anaesthetists must be able to develop a methodical approach to their assessment of neurological injuries to be able to differentiate between anaesthetic and non-anaesthetic causes, and importantly be able to promptly recognize when urgent investigations and management are required to prevent permanent harm to patients. Anaesthetists must understand the principles of good practice when performing neuraxial blocks. This includes taking the recommended precautions to reduce the risk of neurological complications by assessing coagulation status, adhering to infection control measures, appropriate positioning and technique, clear communication with patients, and monitoring the resolution of a neuraxial block post-natally. The anaesthetist must work within the multidisciplinary setting to reduce risk by consulting obstetricians, haematologists and neurologists, as well as providing appropriate follow-up and management for patients with physiotherapy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Anaesthesia & Intensive Care Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cook T.M.
        • Counsell D.
        • Wildsmith J.A.W.
        Major complications of central neuraxial block: report on the third national Audit Project of the royal College of anaesthetists.
        Br J Anaesth. 2009 Feb; 102: 179-190
        • Bamber J.H.
        • Lucas D.N.
        • Plaat F.
        • et al.
        Obstetric anaesthetic practice in the UK: a descriptive analysis of the national obstetric anaesthetic Database 2009–14.
        Br J Anaesth. 2020 Oct; 125: 580-587
        • Loo C.
        • Dahlgren G.
        • Irestedt L.
        Neurological complications in obstetric regional anaesthesia.
        Int J Obst Anaesth. 2000; 9: 99-124
        • Harper R.L.
        • Eckford S.D.
        • Williams H.
        • et al.
        Obstetric neurological injuries.
        Obstet Gynecol. 2020 Oct; 22: 305-312
        • Scott D.B.
        • Tunstall M.E.
        Serious complications associated with epidural/spinal blockade in obstetrics: a two-year prospective study.
        Int J Obstet Anesth. 1995 Jul; 4: 133-139
        • Reynolds F.
        Damage to the conus medullaris following spinal anaesthesia: case reports.
        Anaesthesia. 2001 Mar; 56: 238-247
        • D'Angelo R.
        • Smiley R.
        • Riley E.
        • et al.
        Serious complications related to obstetric anesthesia.
        Anesthesiology. 2014; 120: 1505e12
        • Moen V.
        • Dahlgren N.
        • Irestedt L.
        Severe neurological complications after central neuraxial blockades in Sweden 1990e1999.
        Anesthesiology. 2004; 101: 950e9
        • Ruppen W.
        Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with.
        Epidural Analgesia/Anesthesia. 2006; 105: 6
        • Campbell J.P.
        • Plaat F.
        • et al.
        • Membership of the Working Party
        Safety guideline: skin antisepsis for central neuraxial blockade: association of anaesthetists of Great Britain and Ireland obstetric anaesthetists' association regional anaesthesia UK association of paediatric anaes.
        Anaesthesia. 2014 Nov; 69: 1279-1286
        • Patel S.
        • Robertson B.
        • McConachie I.
        Catastrophic drug errors involving tranexamic acid administered during spinal anaesthesia.
        Anaesthesia. 2019 Jul; 74: 904-914
        • Chambers D.J.
        • Bhatia K.
        • Columb M.
        Postpartum cerebral venous sinus thrombosis following obstetric neuraxial blockade: a literature review with analysis of 58 case reports.
        Int J Obstet Anesth. 2021 Sep; : 103218
        • Yentis S.M.
        • Lucas D.N.
        • Brigante L.
        • et al.
        Safety guideline: neurological monitoring associated with obstetric neuraxial block 2020: a joint guideline by the Association of Anaesthetists and the Obstetric Anaesthetists' Association.
        Anaesthesia. 2020 Jul; 75: 913-919