open access

Ahead of Print
Review paper
Published online: 2021-04-14
Get Citation

Perinatal complications associated with neuraxial blocks

Agata Klimkowicz, Rafal Rutyna, Edyta Kotlinska-Hasiec, Wojciech Dabrowski
DOI: 10.5603/GP.a2021.0047
·
Pubmed: 33914309

open access

Ahead of Print
REVIEW PAPERS Gynecology
Published online: 2021-04-14

Abstract

Regional techniques are the gold standard of obstetric anaesthesia. In both vaginal and Caesarean section deliveries, neuraxial blocks are the most frequently used methods for relieving pain. Although it provides excellent analgesia, regional anaesthesia is associated with certain adverse side effects and possible complications. In this narrative review, we bring together all available data and create a catalogue of complications resulting from the use of perinatal neuraxial anaesthesia which we divide according to their severity and the duration of their impact on patients' health. We focus on complications that have significant or long-term consequences. Even though their incidence is low at 1:1600 neuraxial anaesthetics performed, we believe that better understanding of the possible severe problems that can result from regional anaesthesia procedures would enhance the overall safety of patients during labour, delivery, and the postpartum period. Despite the pivotal role neuraxial techniques play in providing anaesthesia for parturients, there is a lack of good quality studies on the incidence of complications. We believe that a thorough assessment of the occurrence of complications should be carried out by analysing data from nationwide medical databases. By analysing the adverse side effects, both qualitatively and quantitatively, we think it possible to further improve the quality of patient care.

Abstract

Regional techniques are the gold standard of obstetric anaesthesia. In both vaginal and Caesarean section deliveries, neuraxial blocks are the most frequently used methods for relieving pain. Although it provides excellent analgesia, regional anaesthesia is associated with certain adverse side effects and possible complications. In this narrative review, we bring together all available data and create a catalogue of complications resulting from the use of perinatal neuraxial anaesthesia which we divide according to their severity and the duration of their impact on patients' health. We focus on complications that have significant or long-term consequences. Even though their incidence is low at 1:1600 neuraxial anaesthetics performed, we believe that better understanding of the possible severe problems that can result from regional anaesthesia procedures would enhance the overall safety of patients during labour, delivery, and the postpartum period. Despite the pivotal role neuraxial techniques play in providing anaesthesia for parturients, there is a lack of good quality studies on the incidence of complications. We believe that a thorough assessment of the occurrence of complications should be carried out by analysing data from nationwide medical databases. By analysing the adverse side effects, both qualitatively and quantitatively, we think it possible to further improve the quality of patient care.

Get Citation

Keywords

complications; adverse effects; neuraxial anaesthesia; obstetrical anaesthesia; epidural analgesia; spinal anaesthesia

About this article
Title

Perinatal complications associated with neuraxial blocks

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Review paper

Published online

2021-04-14

DOI

10.5603/GP.a2021.0047

Pubmed

33914309

Keywords

complications
adverse effects
neuraxial anaesthesia
obstetrical anaesthesia
epidural analgesia
spinal anaesthesia

Authors

Agata Klimkowicz
Rafal Rutyna
Edyta Kotlinska-Hasiec
Wojciech Dabrowski

References (28)
  1. Wong CA. Advances in labor analgesia. Int J Womens Health. 2010; 1: 139–154.
  2. Butwick AJ, Bentley J, Wong CA, et al. United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women. JAMA Netw Open. 2018; 1(8): e186567.
  3. D'Angelo R, Smiley RM, Riley ET, et al. Serious complications related to obstetric anesthesia: the serious complication repository project of the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2014; 120(6): 1505–1512.
  4. Ferrari R. Writing narrative style literature reviews. Medical Writing. 2015; 24(4): 230–235.
  5. von Peltz C, Bennett A, Patil V. Central neurological complications following obstetric neuraxial blockade. Curr Opin Anaesthesiol. 2019; 32(3): 315–324.
  6. Cook TM, Counsell D, Wildsmith JAW, et al. 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(2): 179–190.
  7. Maronge L, Bogod D. Complications in obstetric anaesthesia. Anaesthesia. 2018; 73 Suppl 1: 61–66.
  8. Ruppen W, Derry S, McQuay H, et al. Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology. 2006; 105(2): 394–399.
  9. Loo CC, Dahlgren G, Irestedt L. Neurological complications in obstetric regional anaesthesia. Int J Obstet Anesth. 2000; 9(2): 99–124.
  10. Scott DB, Tunstall ME. Serious complications associated with epidural/spinal blockade in obstetrics: a two-year prospective study. Int J Obstet Anesth. 1995; 4(3): 133–139.
  11. Bloom SL, Spong CY, Weiner SJ, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Complications of anesthesia for cesarean delivery. Obstet Gynecol. 2005; 106(2): 281–287.
  12. Anim-Somuah M, Smyth RMd, Cyna AM, et al. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018; 5: CD000331.
  13. George RB, Allen TK, Habib AS. Serotonin receptor antagonists for the prevention and treatment of pruritus, nausea, and vomiting in women undergoing cesarean delivery with intrathecal morphine: a systematic review and meta-analysis. Anesth Analg. 2009; 109(1): 174–182.
  14. Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Reg Anesth Pain Med. 2008; 33(3): 241–252.
  15. Goetzl L. Epidural analgesia and maternal fever: a clinical and research update. Curr Opin Anaesthesiol. 2012; 25(3): 292–299.
  16. Kinsella SM. A prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia. 2008; 63(8): 822–832.
  17. Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth. 2004; 13(4): 227–233.
  18. Grau T, Leipold RW, Conradi R, et al. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002; 14(3): 169–175.
  19. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38(1): 1–211.
  20. Goldszmidt E, Kern R, Chaput A, et al. The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anaesth. 2005; 52(9): 971–977.
  21. Choi PT, Galinski SE, Takeuchi L, et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth. 2003; 50(5): 460–469.
  22. Carvalho B. Respiratory depression after neuraxial opioids in the obstetric setting. Anesth Analg. 2008; 107(3): 956–961.
  23. Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration: An Updated Report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2016; 124(3): 535–552.
  24. Baer ET. Post-dural puncture bacterial meningitis. Anesthesiology. 2006; 105(2): 381–393.
  25. Davis L, Hargreaves C, Robinson PN. Postpartum meningitis. Anaesthesia. 1993; 48(9): 788–789.
  26. Beckett VA, Knight M, Sharpe P. The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study. BJOG. 2017; 124(9): 1374–1381.
  27. Mhyre JM, Tsen LC, Einav S, et al. Cardiac arrest during hospitalization for delivery in the United States, 1998-2011. Anesthesiology. 2014; 120(4): 810–818.
  28. Toledo P, Nixon HC, Mhyre JM, et al. Brief report: Availability of lipid emulsion in United States obstetric units. Anesth Analg. 2013; 116(2): 406–408.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl