Neurological complications following central neuraxial blockades in obstetrics

The last few decades have seen an increased use of central neuraxial blockades in obstetric patients. Central blockades provide excellent labour analgesia and safe anaesthesia for caesarean section associated with low incidence of severe complications. Therefore, an increasing number of blockades are also performed in women affected by significant disease. The risks and benefits of central blockades, however, might differ in these patients. This review addresses the risks of neurological complications following central neuraxial blockades in healthy parturients as well as in women affected by significant haemostatic and neurological disease.

The low risk of complications following central neuraxial blockades applies primarily to women in developed countries. Infectious complications and in particular meningitis still occur, and more frequently so in developing countries. Judicious application of central blockades in women affected by neurological and haemostatic disorders may enhance patient satisfaction without increasing the risk for complications.

Estimation of the incidence of neurological complications following central neuraxial blockades to women affected by significant disease on the basis of case reports and small series of patients is impossible. Prospective registration of high-risk patients may increase our knowledge. Application of central neuraxial blockade must follow individual evaluation.