Safety guideline: neurological monitoring associated with ob
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The Royal College of Anaesthetists’ Faculty of Pain Medicine has published guidance on management of continuous epidural analgesia, with input from several multispecialty and multidisciplinary groups – but these specifically exclude the obstetric setting. This guidance already sets out the need for regular sensory and motor block assessment in the non‐obstetric population.

Serious neurological lesions such as vertebral canal haematoma are rare after obstetric regional analgesia/anaesthesia, but early detection may be crucial to avoid permanent damage. This may be hampered by the variable and sometimes prolonged recovery following ‘normal’ neuraxial block, such that an underlying lesion may easily be missed. These guidelines make recommendations for the monitoring of recovery from obstetric neuraxial block, and escalation should recovery be delayed or new symptoms develop, with the aim of preventing serious neurological morbidity.

Key Recommendations:

1.During labour, the anaesthetist should be alerted if a woman is unable to straight‐leg raise (being able to raise the heel off the bed against gravity, even if not sustained). Although minor degrees of motor block are common, even with modern low‐dose techniques, any woman with profound motor and sensory block should be assessed by the anaesthetist and where there is concern, management should be further escalated.

2.During the recovery phase after a spinal anaesthetic or epidural top‐up for a procedure, straight‐leg raising should be used as a screening method to assess motor block. If the woman is unable to straight‐leg raise at 4 h from the last dose of epidural/spinal local anaesthetic, the anaesthetist should be called to assess whether the woman's care should be escalated to investigate the possibility of reversible causes of neurological injury.

3.Women should be informed of the likely timescale for resolution of their neuraxial block and encouraged to alert staff should this be delayed.

4.Each maternity unit should have a guideline/policy in place to guide the escalation of care, depending on local resources/referral pathways. There should also be a guideline/policy for the assessment and management of postpartum women who present with neurological deficit after discharge from hospital.

Neuraxial analgesia/anaesthesia is widely used in the obstetric setting. Serious neurological complications are rare, but early detection is important to reduce or prevent permanent harm. This document has been produced to guide the neurological monitoring of obstetric patients who receive neuraxial analgesia or anaesthesia, in order to support earlier detection and minimise harm.

About the society:

Royal College of Midwives. Midwifery Care in Labour Guidance for all Women in all Settings. London: RCM, 2018.

Note: This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice

Kindly refer to the original publication here:

https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14993?af=R
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