Neurological complications in obstetric regional anaesthesia

Central neuraxial blocks are the commonest procedures performed in obstetric anaesthesia. Most post-partum neurological complications are obstetric palsies caused by the process of normal labour itself. However, anaesthetists must be able to develop a methodical approach to their assessment of neurological injuries to be able to differentiate between anaesthetic and non-anaesthetic causes, and importantly be able to promptly recognize when urgent investigations and management are required to prevent permanent harm to patients. Anaesthetists must understand the principles of good practice when performing neuraxial blocks. This includes taking the recommended precautions to reduce the risk of neurological complications by assessing coagulation status, adhering to infection control measures, appropriate positioning and technique, clear communication with patients, and monitoring the resolution of a neuraxial block post-natally. The anaesthetist must work within the multidisciplinary setting to reduce risk by consulting obstetricians, haematologists and neurologists, as well as providing appropriate follow-up and management for patients with physiotherapy.