Paraesthesiae and nerve damage following combined spinal epidural and spinal anaesthesia: a pilot survey

Concern has been expressed that recent changes in techniques of spinal blockade may have resulted in an increase in frequency of neurological sequelae. In order to make preliminary enquiries about anaesthetists' recent experiences of neurological sequelae following spinal and combined spinal-epidural anaesthesia, a questionnaire, covering numbers of procedures, needles used and any neurological problems that had been encountered, was sent to the anaesthetist in charge of each obstetric centre on the Royal College of Obstetricians and Gynaecologists' United Kingdom list. Replies were received from 222 of the 259 units, of whom 40 reported a total of 56 cases involving prolonged neurological sequelae, of which nine were probable obstetric palsies, 18 could be attributed to the regional procedure (one instance of conus damage and the rest largely sensory disturbances) and 29 were of uncertain origin, including a second conus damage. There was no obvious difference in incidence of problems associated with combined spinal-epidural vs. the single-shot spinal technique (odds ratio 1.14, confidence interval 0.53 to 2.46), or Sprotte vs. Whitacre atraumatic needle (odds ratio 1.40, confidence interval 0.64 to 3.08). A prospective survey, or better still, randomisation would be needed to verify these findings.