You are the duty anaesthetist and you receive a phone call from a midwife on the postnatal ward asking if you can come and review a woman who gave birth yesterday. She is 29 years old, with a BMI of 39 and gestational diabetes. She had an epidural placed in labour ward for analgesia - which she describes as being a difficult and unpleasant procedure. Following a prolonged and difficult labour she was taken to theatre and required an instrumental delivery in theatre under epidural - this too was difficult and she was in the lithotomy position for well over an hour for both the delivery and then the subsequent perineal repair. Today she is complaining of a "numb left leg". She and the midwife are concerned she has a nerve injury from the epidural. What should be your approach to this difficult situation?

Hi everyone,

Join Graeme and I for the second part in our series on complications of central neuraxial blockade and postpartum neurological injuries. We will discuss the specific issue of neurological problems - with the take home point being that in fact the underlying cause of the majority of these are related to the process of childbirth and not a direct injury from the epidural / spinal itself. There are however a few rare serious neurological conditions that need rapid diagnosis and treatment in order to avoid what could lead to catastrophic irreversible neurological injury.

REFERENCES

Neurologic Deficits and Labor Analgesia Cynthia A Wong M.D. Regional Anesthesia and Pain Medicine Vol 29, 4, 2004: pp341-351