Postpartum neurological symptoms following regional blockade: a prospective study with case controls

We undertook a 12-month prospective study to establish the incidence, nature and significance of postpartum neurological symptoms. To explore the effects of regional blockade, obstetric intervention and neurological examination, women with symptoms after regional blockade were matched with two asymptomatic case controls, one with similar regional blockade and obstetric intervention and another without either regional blockade or obstetric intervention. Twenty-two of 2615 women who had received regional blockade and one of 1376 who had not, presented with postpartum neurological symptoms (incidence 5.8:1000). Presentation with symptoms was associated with regional blockade (P = 0.003) but may reflect reporting bias. Sixty-three women were recruited and examined in a standardised manner. Neurological deficits were identified in all groups. Twelve women were readily diagnosed with obstetric palsies, all of which were associated with vaginal rather than caesarean delivery (P = 0.003). Four of these women had not volunteered symptoms before examination. Six women reported lower sacral dermatome numbness of unknown aetiology but associated with caesarean delivery (P = 0.002). Non-anatomical sensory loss in four of 21 women with symptoms was also noted in 10% of the controls and is likely to be of little clinical significance. Sixteen women who had presented with symptoms completed a 6-month follow-up interview. Thirteen had no symptoms and three had residual sensory symptoms but no functional impairment. These results confirm that postpartum neurological dysfunction is more frequent if specifically sought, and support the clinical impression that significant neurological deficits occur irrespective of the use of regional anaesthesia.