Incidence of neurological complications and post-dural puncture headache after regional anesthesia in obstetric practice: A retrospective study of 2399 patients

  • Domingos Dias Cicarelli Anesthesiologist, Anesthesia Division of Hospital Universitario da Universidade de Sào Paulo, Sáo Paulo, Brazil
  • Elke Frerichs Anesthesiologist, Anesthesia Division of Hospital Universitario da Universidade de Sào Paulo, Sáo Paulo, Brazil
  • Fábio Ely Martins Benseñor Anesthesiologist, Anesthesia Division of Hospital Universitario da Universidade de Sào Paulo, Sáo Paulo, Brazil
Keywords: Anesthesia, Obstetrical Anesthesia, Conduction Analgesia, Anesthesia Epidural, Nerve Block

Abstract

Introduction and objectives:Regional anesthesia provides excellent anesthesia and analgesia in obstetric patients, but has potential for complications such as post-dural puncture headache and permanent or transient nerve damage. This study aimed to describe the incidence of post-dural puncture headache and nerve damage in the obstetric population of a university hospital that was submitted to neuraxial blockades, comparing with the world literature, and identify risk factors.
Materials and methods: A retrospective cohort was performed including data collected in the records of post-anesthetic consults conducted during the year 2010. The main analysis was performed on the complaints of peripheral neurological deficits and headaches reported by patients, type of anesthesia and performed surgical procedures. A multiple regression analysis was performed to investigate the association between the onset of lower limb paresthesias and the length of stay of these patients in the gynecological position and other variables.
Results: A total of 2399 pregnant patients who had undergone neuraxial blockade were evaluated. Neurologic complications that occurred in these patients were divided into lower limb paresthesias (0.3%), transient radicular irritation (0.1%), and post-dural puncture headache (3%). The patients who stayed more than 60 min in gynecological position showed an odds ratio of evolution with lower limb paresthesias of 1.75 and patients who stayed more than 120 min showed an odds ratio of 2.1, but without statistical significance.
Conclusions:Patients submitted to neuraxial blockades and placed in gynecological position were more likely to evolve with lower limb paresthesias related to duration of this position.

References

1. Brull R, McCartney CJL, Chan VWS, el-Beheiry H. Neurological complications after regional anesthesia: Contemporary estimates of risk. Anesth Analg. 2007;104:965-74.
2. Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: A meta-analysis. Anesth Analg. 2001;93:853-8.
3. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural and spinal anaesthesia: Results from overview of randomized trials. BMJ. 2000;321:1493.
4. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: A meta-analysis of randomized trials. Br J Anaesth. 2000;84:450-5.
5. Wu CL, Hurley RW, Anderson GF, Herbert R, Rowlingson AJ, Fleisher LA. Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients. Reg Anesth Pain Med. 2004;29:525-33.
6. Loubert C, Hinova A, Fernando R. Update on modern neuraxial analgesia in labour: A review of the literature of the last 5 years. Anaesth. 2011;66:191-217.
7. Blanshard HJ, Cook TM. Use of combined spinal-epidural by obstetric anesthetists. Anaesth. 2004;59:922-3.
8. Rawal N. Combined spinal-epidural anaesthesia. Curr Opin Anaesthesiol. 2005;18:518-21.
9. Preston R. The role of combined spinal epidural analgesia for labour: Is there still a question? Can J Anesth. 2007;54:9-14.
10. Cortes CA, Sanchez CA, Oliveira AS, Sanchez FM. Labor analgesia: A comparative study between combined spinal-epidural anesthesia versus continous epidural anesthesia. Rev Bras Anestesiol. 2007;57:39-51.
11. Abrao KC, Francisco RPV, Miyadahira S, Cicarelli DD, Zugaib M. Elevation of uterine basal tone and fetal heart rate abnormalities after labor analgesia: A randomized controlled trial. Obstet Gynecol. 2009;113:41-7.
12. Cicarelli DD, Silva RV, Frerichs E, Pagnocca ML. Combined spinal-epidural for labor analgesia: Does the addition of sufentanil to the local anesthetic influence Apgar scores of the newborn? Rev Bras Anestesiol. 2007;57:272-9.
13. Jadon A. Complications of regional and general anaesthesia in obstetric practice. Indian J Anaesth. 2010;54: 415-20.
14. Cooper G, McClure J. Maternal deaths from anesthesia. An extract from Why Mothers Die 2000-2002, the Confidential Enquiries into Maternal Deaths in the United Kingdom: Chapter 9: Anaesthesia. Br J Anaesth. 2005;94:417-23.
15. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: A meta-analysis of obstetrical studies. Can J Anaesth. 2003;50:460-9.
16. American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: An updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiol. 2007;106:843-63.
17. Tanaka PP, Tanaka MAA. Sintomas neurológicos transitónos após raquianestesia. Rev Bras Anestesiol. 2004;54:108-13.
18. Auroy Y, Benhamou D, Barques L, Ecoffey C, Falissard B, Mercier FJ, et al. Major complications of regional anesthesia in France: The SOS regional anesthesia hotline service. Anaesthesiol. 2002;97:1274-80.
19. Ganem EM, Castiglia YMM, Vianna PTG. Complicares neurológicas determinadas pela anestesia subaracnóidea.Rev Bras Anestesiol. 2002;52:471-80.
20. Reynolds F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia. 2001;56:235-47.
21. Puolakka R, Haasio J, Pitkanem M, Kallio M, Rosenberg PH. Technical aspects and postoperative sequelae of spinal and epidural anesthesia: A prospective study of 3230 orthopedic patients. Reg Anesth Pain Med. 2000;25:488-97.
22. Imbelloni LE, Sobral MGC, Carneiro ANG. Cefaléia pós-raquianestesia e o desenho das agulhas. Rev Bras Anestesiol. 2001;51:43-52.
23. Horlocker TT, Wedel DJ. Neurologic complications of spinal and epidural anesthesia. Reg Anesth Pain Med. 2000;25:83-98.
24. Mendes FF, Luft A, Gomes LC. Déficit neurológico após bloqueio espinhal. Relato de caso. Rev Bras Anestesiol. 1999;49:38-9.
25. Barbosa JS, Rabello RP, Saraiva RA, Vieira ZEG, Rossi AMC. Lesao de nervo periférico nem sempre é complicacao da anestesia regional. Rev Bras Anestesiol. 1992;42:239-42.
26. Navarro Vargas JRN, Luquetta Berrio JAL, Tejada López ET. Lesión nerviosa periférica secundaria a anestesia regional subaracnoidea en paciente ginecobstétrica. Rev Colomb Anestesiol. 2009;37:71-8.
27. Wlody D. Complications of regional anesthesia in obstetrics. Clin Obstet Gynecol. 2003;46:667-78.
28. Greensmith JE. Complications of regional anesthesia. Curr Opin Anaesthesiol. 2006;19:531-7.
29. Turnbull D, Shepherd B. Post-dural puncture headache: Pathogenesis, prevention and treatment. Br J Anaesth. 2003;91:718-29.
30. Lorri AL, Karen LP. Injuries associated with regional anesthesia in the 1980s and 1990s: A closed claims analysis. Anesthesiol. 2004;101:143-52.
31. Quintero IF, Candamil A, Mantilla JHM, Medina H, Cadena FA. Intracranial hypotension syndrome: A post dural puncture headache? Rev Colomb Anestesiol. 2013;41:57-60.
32. Grande PO. Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture — a physiological approach. Acta Anaesthesiol Scand. 2005;49:619-26.
33. Diaz JH. Epidemiology and outcome of postdural headache management in spontaneous intracranial hypotension. Reg Anesth Pain Med. 2001;26:293-6.
34. Gonzalez CEM, Enriquez LE, Cruz CA. Arachnoiditis following spinal anesthesia for cesarean section. Rev Colomb Anestesiol. 2012;40:150-2.
35. Moen V, Irestedt L. Neurological complications following central neuraxial blockades in obstetrics. Curr Opin Anaesthesiol. 2008;21:275-80.
36. Aldrete JA. Neurologic deficits and arachnoiditis following neuroaxial anesthesia. Acta Anaesthesiol Scand. 2003;47: 3-12.
37. Rice I, Wee MY, Thomson K. Obstetric epidurals and chronic adhesive arachnoiditis. Br J Anaesth. 2004;92:109-20.
38. Wong CA, Scavone BM, Dugan S, Smith JC, Prather H, Ganchiff JN, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol. 2003;101:279-88. [
39. Villar GCP, Roas C, Cappelli EL, Rosa MCR. Incidencia de cefaléia pós-raquianestesia em pacientes obstétricas com o uso de agulha Whitacre calibre 27G. Experiencia com 4570 casos. Rev Bras Anestesiol. 1999;49:110-2.
40. Ben-David B, Rawa R. Complications of neuraxial blockade. Anesthesiol Clin North America. 2002;20:669-93.
41. Neves JFNP, Vieira VLR, Saldanha RM, Vieira FAD, Neto MC, Magalhaes MG, et al. Uso da hidrocortisona no tratamento e na prevencao da cefaléia pós-puncao da dura-máter. Relato de casos. Rev Bras Anestesiol. 2005;55:343-9.
42. Davignon KR, Dennehy KC. Update on postdural puncture headache. Int Anesthesiol Clin. 2002;40:89-102.
43. Safa-Tisseront V, Thormann F, Malassine P, Henry M, Riou B, Coriat P, et al. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiol. 2001;95:334-9.
44. Cousins MJ, Brazier D, Cook R. Intracranial hypotension caused by cervical cerebrospinal fluid leak: Treatment with epidural blood patch. Anesth Analg. 2004;98:1794-7.
45. Cicarelli DD, Stábile Jr SL, Guimaraes CM, Nishida MM. Cefaléia pós-puncao de duramáter em paciente HIV positivo: qual o melhor tratamento. Rev Bras Anestesiol. 2000;50:306-8.
46. Kleinman W. Obstetric anesthesia. En: Morgan Jr GE, Mikhail MS, Murray MJ, editores. Clinical Anesthesiology. 3rd ed. New York: McGraw-Hill Companies Inc.; 2002. p. 819.
47. Santos AC, O'Gorman DA, Finster M. Obstetrical Anesthesia, Chapter 43. En: Barach PG, Cullen BF, Stoelting RK, editores. Clinical Anesthesia. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 1141.
48. Hall BA, Chantigian RC. Obstetric Physiology and Anesthesia, Chapter 8. En: Hall BA, Chantigian RC, editores. Anesthesia, a Comprehensive Review. 4th ed. Missouri: Mosby Elsevier;2010. p. 208.
49. Martins CEC, Cangiani LM, editores. Tratado de Anestesiologia. 7th ed. Sao Paulo: Atheneu; 2011. p. 2283.
50. Rodrigues FR, Brandao MJN. Anestesia regional para cesariana em gestantes obesas: estudo retrospectivo. Rev Bras Anestesiol. 2011;61:13-20
How to Cite
1.
Dias Cicarelli D, Frerichs E, Martins Benseñor FE. Incidence of neurological complications and post-dural puncture headache after regional anesthesia in obstetric practice: A retrospective study of 2399 patients. Colomb. J. Anesthesiol. [Internet]. 2014Jan.1 [cited 2022Jul.6];42(1):28–32. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/620

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Published
2014-01-01
How to Cite
1.
Dias Cicarelli D, Frerichs E, Martins Benseñor FE. Incidence of neurological complications and post-dural puncture headache after regional anesthesia in obstetric practice: A retrospective study of 2399 patients. Colomb. J. Anesthesiol. [Internet]. 2014Jan.1 [cited 2022Jul.6];42(1):28–32. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/620
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