Delayed Complications Of Obstetric Regional Anaesthesia
Ross AW, Hayes NE, Eager MC, Moles AJ, Hiscock RJ, Wheelahan JM.
Departments of Anaesthesia and Perioperative Services
Mercy Hospital for Women
Heidelberg 3084
Purpose of Study
To determine the incidence of delayed complications after regional anaesthesia, presenting post discharge at a major tertiary obstetric centre.
Method
Over the period from May 2004 to December 2006, with ongoing institutional ethical committee approval, a prospective study of all obstetric patients receiving regional anaesthesia for analgesia and delivery was made. All patients were routinely reviewed after regional anaesthesia at 24 – 48 hrs post delivery by a member of the dedicated pain service. After review, all patients were provided with a pre-printed discharge advice form highlighting possible delayed symptoms that might occur. A 24 hour direct contact number to the duty emergency registrar or pain nurse was provided. Patients were subsequently reviewed by phone consultation or direct examination, depending on the nature of the concern.
Result
A total of 11978 women delivered during this period. 6287 patients received regional anaesthesia and were reviewed post delivery. A total of 89 patients reported 101 symptoms after discharge. The time range from anaesthesia to report of symptoms was 3 – 200 days. Most contacts were initiated by direct phone contact. Most symptoms were judged to be self limiting and settled with frequent phone review. Seventeen of the 89 patients either presented directly to the hospital or required attendance for further management. Headache was the commonest complication reported (42 cases). Lower limb weakness and sensory changes were reported in a further 27. Backache occurred in 25 patients. Thirteen required physician referral (10 to a neurologist) and 8 imaging or nerve conduction studies.
Conclusion
The potential for development of delayed complications after obstetric regional anaesthesia is low but real.
Time of Presentation
1030
