Safety Guideline: Neurological Monitoring Associated With Obstetric Neuraxial Block 2020 A Joint Guideline by the Association of Anaesthetists and the Obstetric Anaesthetists’ Association

Abstract

(Anaesthesia. 2020;75:913–919) Early detection of neurological complications following a neuraxial procedure is essential to minimizing harm. Previous guidelines for management of neuraxial anesthesia lack guidance on neurological monitoring or are not specific to obstetric patients. The recommendations in this paper were produced by representatives from the Association of Anesthetists and Obstetric Anesthetists’ Association with the goal to guide monitoring and management of neurologic recovery in obstetric patients following neuraxial block.

Prevention and management of intra‐operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach

“…The Bromage scale and multiple modifications have been used to describe motor block [19,20]. An increasing proportion of anaesthetists use the straight leg raise test to avoid confusion [21].…”

Spinal prilocaine for caesarean section: walking a fine line

“…The study’s cohort mean BMI was 27 kg.m −2 and mean surgical duration was 26 min, making the results unrepresentative of many centres, where women with higher BMIs and longer surgical duration are the norm [8]. Recovery of motor block following neuraxial anaesthesia is very important to assess, however it is not a requirement for PACU discharge in most institutions [9]. A joint guideline by the Association of Anaesthetists and the Obstetric Anaesthetists’ Association recommends that women recovering from neuraxial anaesthesia should be assessed for ability to straight‐leg raise 4 h following the last epidural or spinal local anaesthetic dose [9], but this may be aligned with other routine post‐delivery observations and should not preclude discharge from PACU.…”

“You test because you cannot afford to make assumptions”

“…The guidelines also advise that since sensory block testing is subject to accurate interpretation by the woman, it must always be accompanied by confirmation of motor block with the inability to perform a straight leg raise. This motor block assessment is less complicated than the Bromage score, as highlighted in recent joint Association of Anaesthetists/OAA guidelines for neurological monitoring following obstetric neuraxial block [21].…”