(Anaesthesia. 2017;72:755–759)
Neuraxial anaesthesia is widely used for both labor analgesia and cesarean delivery in the United Kingdom. The risk of neurological complications with these procedures is very low in the obstetric population. However, when they do occur, early detection and management are especially important as their consequences could be critical to the patient. The Third National Audit Project of the Royal College of Anaesthetists recommended that local guidelines be put in place that provide recommendations for patient monitoring to identify early signs and symptoms as well as a process for involving anesthesiologists when problems are identified. National guidelines have been developed that address postoperative monitoring of non-obstetric patients who have received neuraxial anesthesia. However, those guidelines intentionally exclude parturients, and national guidelines specific to the obstetric population still do not exist.
Neuraxial anaesthesia is widely used in obstetrics and neurological complications are rare. However, when they occur, subsequent investigation and management are time-critical and correlate with the extent of neurological recovery. The Third National Audit Project recommended the implementation of guidelines in obstetric epidural management, including advice on monitoring for early signs of problems and acting upon concerns. However, no national guideline exists for postoperative management in the obstetric population. We conducted a national survey of monitoring after obstetric neuraxial blockade and the management of an abnormally prolonged block. We received responses from 112/189 (59.3%) obstetric anaesthetic leads invited to participate. We determined that post-neuraxial blockade monitoring in the UK is highly variable: only 63/112 (56.3%) respondents' units had a monitoring policy in place, although most of these did not undertake formal neurological monitoring, and a range of different monitoring methods and schedules were employed. In 12/63 (19%) local policies, the first review of neurology was performed at the standard postoperative visit the following day, and 66/112 (58.9%) units had no protocol in place to address emergency management of abnormally prolonged neuraxial blockade. Where a policy was in place, the initial recommended action and the type of imaging used were variable.
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