You are the anaesthetist allocated to the anaesthetic outpatient clinic and you are asked to see a pregnant patient who is expecting her second child in a few months time who has been referred by a midwife from the antenatal services. She tells you that she had her first child three years earlier and that it was a very difficult and unpleasant experience. After a long difficult labour she asked for an epidural for pain relief. She describes that it was a very painful experience being placed and then it didn't work properly and despite being numb in her left leg she was still in a lot of pain. She then went to theatre for an emergency instrumental delivery - the anaesthetist there replaced it with "a new epidural" and she says she almost passed out and had trouble feeling her hands and breathing for about 30min. After delivery she had a numb patch on her left thigh and some musculoskeletal back pain for 6 months which she says a number of people have told her "were probably due to the epidural". She is very anxious about what will happen this time - she wants good pain relief during the labour because she had a lot of difficulty coping with the labour pain last time but is very worried about having another "epidural". She has also been told her baby is bigger this time and she might need to have a caesarean.

She wants you to give her a detailed explanation of the known risks / complications of epidural analgesia and or anaesthesia should she need a caesarean. What are these and how will you explain these to her without making her anxiety even worse!

Hi everyone,

This week Graeme and I are back to discuss the known complications of central neuraxial blockade - or spinals and epidurals - in obstetrics. This week we will discuss all the known problems and complications that can occur - how to explain so the average lay person can understand them and doing it without scaring them to death! We refer heavily to NAP3 the great national audit project conducting in the UK and published in 2009 which highlights the overall safety of central neuraxial blockade and luckily how rare devastating neurological complications are. Next episode we will focus more specifically on the neurological injuries & deficits following childbirth and the specific causes (most of which are unrelated to the epidural or spinal!).

REFERENCES

National Audit of Major Complications of Central Neuraxial Block in the United Kingdom Report and Findings, January 2009