Neurologic complications of neuraxial analgesia for labor

In today's anesthesia practice, provision of neuraxial anesthesia and analgesia is increasing. Along with the patient's fear of paralysis that accompanies placement of a needle near the spinal cord, any subsequent nerve deficit is usually blamed on the neuraxial block provided. Knowing the side effects from labor, neuraxial anesthesia or both is important as anesthesiologists are the first consultants to evaluate whenever a complication arises in these patients if there is a sensory or motor deficit in the lower extremities.

Neuraxial anesthesia may be associated with complaints of back pain, postdural puncture headache and severe complications (e.g., hematoma, abscess), but most complications following neuraxial blocks are associated with pregnancy and delivery, not the anesthetic. Signs and symptoms of the most common neurologic complications are described so that the clinician can promptly diagnose and treat these patients and seek appropriate consultation.

Even though the incidence of true neurologic complications arising from neuraxial anesthesia is not known, they appear to be very rare. As anesthesiologists, providing care encompasses knowing the side effects and complications of the anesthetic we provide. Many of the nerve palsies that present in the postpartum patient may be of an obstetric origin, but anesthesiologists should be aware of anesthetic-related complications.