Neurological Complications in Obstetric Regional Anesthetic Practice

1. Ade Wijaya, MD – July 2020

2. INTRODUCTION
 Although rare, neurological complications
following regional anesthesia can occur
 Prompt recognition and appropriate
management are of the utmost importance in
reducing the risk of permanent neurological
impairment
NHS. Maternity Statistics 2012-2013; December 5, 2013.
Loo CC, Dahlgren G, Irestedt L. Neurological complications in obstetric regional anaesthesia. Int J Obstet Anesth 2000;9:99-124.

3. EPIDEMIOLOGY
 Neurological pathology following delivery
may occur in up to 1 in 100 women
- Non anesthetic (more common)
- Anesthetic (1 in 3900)
Usually transient; rarely permanent
Wong CA, Scavone BM, Dugan S, Smith JC, Prather H, Ganchiff JN, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol
2003;101:279-88.
Wong CA. Neurologic deficits and labor analgesia. Reg Anesth Pain Med 2004;29:341-51.
Ruppen W, Derry S, McQuay H, Moore RA. Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia.
Anesthesiology 2006;105:394-9

4. ANATOMY

5. NON ANESTHETIC ETIOLOGY
Scott DB, Hibbard BM. Serious non-fatal complications associated with extradural block in obstetric practice. Br J Anaesth 1990;64:537-41
Wong CA, Scavone BM, Dugan S, Smith JC, Prather H, Ganchiff JN, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol
2003;101:279-88.

6. ANESTHETIC ETIOLOGY
Duncan A, Patel S. Neurological complications in obstetric regional anesthetic practice. Journal of Obstetric Anaesthesia and Critical Care. 2016 Jan 1;6(1):3.

7. DIAGNOSIS
Duncan A, Patel S. Neurological complications in obstetric regional anesthetic practice. Journal of Obstetric Anaesthesia and Critical Care. 2016 Jan 1;6(1):3.

8. DIAGNOSTIC INVESTIGATIONS
 Laboratory
 CSF analysis
 MRI
 Electrodiagnostic studies
Cook TM, Counsell D, Wildsmith JA; Royal College of Anaesthetists Third National Audit Project. Major complications of central neuraxial block: Report on the Third National
Audit Project of the Royal College of Anaesthetists. Br J Anaesth 2009;102:179-90.
Duncan A, Patel S. Neurological complications in obstetric regional anesthetic practice. Journal of Obstetric Anaesthesia and Critical Care. 2016 Jan 1;6(1):3.

9. Duncan A, Patel S. Neurological complications in obstetric regional anesthetic practice. Journal of Obstetric Anaesthesia and Critical Care. 2016 Jan 1;6(1):3.

10. PROGNOSIS
 Compressive Neuropathies: 2 months
 Ischaemic Neuropathies: 24 hours
 Traumatic Neuropathies: 1 year; rare:
permanent
 Hematoma/abscess: could be permanent if
not treated well
 Meningitis/arachnoiditis: good if adequately
treated
Duncan A, Patel S. Neurological complications in obstetric regional anesthetic practice. Journal of Obstetric Anaesthesia and Critical Care. 2016 Jan 1;6(1):3.

11. SUMMARY
 Although rare, neurological complications
following regional anesthesia can occur
 Usually transient
 Prompt recognition and appropriate
management  to prevent permanent nerve
damage