Jo Davies

General Information When performing neuraxial procedures, the right drug injected into the wrong place (e.g., local anesthetic [LA] injected intravascularly) or the wrong drug injected into the right place (e.g., 2-chloroprocaine injected intrathecally) can both cause neurologic complications. 1. Systemic Local Anesthetic Toxicity Unrecognized injection of large doses of LA into an epidural vein during…

Pre-existing Neurologic Disorders Neuraxial analgesia/anesthesia should not be automatically denied to pregnant women with preexisting neurologic disorders. Ideally, these patients should be evaluated in a high-risk obstetric clinic during pregnancy. This allows for a thorough history and physical examination to gauge the extent and severity of the problem (particularly the distribution of sensory and motor…

General Information In the ASA Closed Claims Database, nerve injury was the most common cause of maternal injury in obstetric anesthesia claims from 1990 on. 1. Incidence Intrinsic obstetric neuropathies related to labor and the mode of delivery are much more prevalent than those caused by direct trauma of needles and catheters used in neuraxial…

General Information Meningitis and epidural abscess are two serious infections associated with neuraxial techniques. Incidence The rarity of both these conditions makes it almost impossible to accurately estimate the incidence of each, with huge variation among studies and surveys. Issues with reporter bias, unknown denominators, changing practice over time, varying operator experience, and population risk…

General Information Epidural hematoma is a rare but potentially catastrophic condition that may be associated with a neuraxial procedure. 1. Incidence The true risk is difficult to determine for multiple reasons, including underreporting and unknown denominators. A recent meta-analysis of 4 studies post-1990 which involved more than 1 million obstetric patients found an incidence of…

General Information A postdural puncture headache (PDPH) can occur following deliberate dural puncture with a spinal needle or after an unintentional dural puncture with an epidural needle. 1. Incidence The overall incidence of unintentional dural puncture with an epidural needle is considered to be 1.5%. This may be lower or higher, depending on the experience…