Strategies for preventing nerve injuries in obstetric anesthesia: a review

Neuraxial anesthesia is widely used for labor analgesia and cesarean delivery, and although serious complications are uncommon, neurological injury remains a source of patient morbidity and medicolegal concern. Ongoing advances in obstetric anesthesia practice, including evolving imaging techniques and increased recognition of postpartum neurological deficits, make a contemporary review of risk factors and preventive strategies timely and clinically relevant.

Recent literature indicates that postpartum neurological injuries are multifactorial, involving obstetric, anatomical, positional, and procedural factors. Anatomical variability, difficulty in identifying vertebral interspaces, and multiple needle attempts increase procedural risk. Emerging evidence supports the use of preprocedural ultrasound to improve accuracy of level identification, reduce attempts, and enhance first-pass success, particularly in patients with challenging anatomy. Structured postpartum neurological assessment has also been emphasized to facilitate early recognition and appropriate management of deficits.

Neurological complications following obstetric neuraxial anesthesia are rare but clinically significant. Individualized anesthetic planning, careful technique, judicious use of ultrasound guidance, and systematic postpartum neurological evaluation represent key strategies to minimize risk. Continued education and research are needed to further refine preventive approaches and optimize maternal safety.