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Postpartum neurologic symptoms following single-shot spinal block for labour analgesia.
Acta Anaesthesiol Scand. 2005 Aug; 49(7):1015-22.AA

Abstract

BACKGROUND

As part of a quality assurance program, we investigated the incidence of postpartum neurologic symptoms in multiparous parturients receiving spinal block for labour analgesia, now in routine use in our labour ward.

METHODS

Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting spinal analgesia were asked to participate in this prospective study. All parturients received our standard intrathecal analgesia (ITA): 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) using a 27-gauge Quincke-type needle. The patients filled in a questionnaire on the first day after delivery and again upon discharge. Complaints typical of neurologic sequelae were noted and a neurologic examination was performed, if necessary. All patients with postdural puncture headache (PDPH) and transient neurologic symptoms (TNSs) were interviewed by telephone 2 weeks after discharge to determine the course of the symptoms.

RESULTS

Two hundred and twelve parturients were included in the study. Eighteen (8.5%) parturients complained of PDPH, the severity of which was mild in eight (4%), moderate in seven (3%), and severe in three (1%) patients, respectively. Fifteen (7%) mothers were treated with analgesics or bedrest only. Three (1%) patients were given an epidural blood patch. The paramedian approach was associated with the development of PDPH (P = 0.04). Transient neurologic symptoms were experienced by nine (4.2%) mothers, lasting 1-3 days, mostly presenting as bilateral pain in the buttocks or thighs. One parturient suffered from paraesthesia of the left foot lasting for 3 days. Forty (19%) mothers complained of non-postural headache and 28 (13%) of new-onset back pain. Three mothers (1%) would not want to receive a further spinal block.

CONCLUSION

Transient neurologic symptoms (TNSs) after spinal block occurred infrequently. The incidence of PDPH was higher than in the obstetric population in general and calls for re-evaluation of our spinal block methods. Despite the occurrence of neurologic sequelae, patient acceptability was high.

Authors+Show Affiliations

Viitanen H
Department of Anaesthesiology, Central Hospital of Seinajoki, Seinajoki, Finland. hanna.viitanen@epshp.fi
Porthan L
No affiliation info available
Viitanen M
No affiliation info available
Heula AL
No affiliation info available
Heikkilä M
No affiliation info available

MeSH

AdultAnalgesia, ObstetricalAnesthesia, SpinalFemaleHeadacheHumansIncidenceMiddle AgedPregnancyProspective StudiesSpinal Cord

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16045665

Citation

Viitanen, H, et al. "Postpartum Neurologic Symptoms Following Single-shot Spinal Block for Labour Analgesia." Acta Anaesthesiologica Scandinavica, vol. 49, no. 7, 2005, pp. 1015-22.
Viitanen H, Porthan L, Viitanen M, et al. Postpartum neurologic symptoms following single-shot spinal block for labour analgesia. Acta Anaesthesiol Scand. 2005;49(7):1015-22.
Viitanen, H., Porthan, L., Viitanen, M., Heula, A. L., & Heikkilä, M. (2005). Postpartum neurologic symptoms following single-shot spinal block for labour analgesia. Acta Anaesthesiologica Scandinavica, 49(7), 1015-22.
Viitanen H, et al. Postpartum Neurologic Symptoms Following Single-shot Spinal Block for Labour Analgesia. Acta Anaesthesiol Scand. 2005;49(7):1015-22. PubMed PMID: 16045665.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postpartum neurologic symptoms following single-shot spinal block for labour analgesia. AU - Viitanen,H, AU - Porthan,L, AU - Viitanen,M, AU - Heula,A-L, AU - Heikkilä,M, PY - 2005/7/28/pubmed PY - 2005/11/4/medline PY - 2005/7/28/entrez SP - 1015 EP - 22 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 49 IS - 7 N2 - BACKGROUND: As part of a quality assurance program, we investigated the incidence of postpartum neurologic symptoms in multiparous parturients receiving spinal block for labour analgesia, now in routine use in our labour ward. METHODS: Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting spinal analgesia were asked to participate in this prospective study. All parturients received our standard intrathecal analgesia (ITA): 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) using a 27-gauge Quincke-type needle. The patients filled in a questionnaire on the first day after delivery and again upon discharge. Complaints typical of neurologic sequelae were noted and a neurologic examination was performed, if necessary. All patients with postdural puncture headache (PDPH) and transient neurologic symptoms (TNSs) were interviewed by telephone 2 weeks after discharge to determine the course of the symptoms. RESULTS: Two hundred and twelve parturients were included in the study. Eighteen (8.5%) parturients complained of PDPH, the severity of which was mild in eight (4%), moderate in seven (3%), and severe in three (1%) patients, respectively. Fifteen (7%) mothers were treated with analgesics or bedrest only. Three (1%) patients were given an epidural blood patch. The paramedian approach was associated with the development of PDPH (P = 0.04). Transient neurologic symptoms were experienced by nine (4.2%) mothers, lasting 1-3 days, mostly presenting as bilateral pain in the buttocks or thighs. One parturient suffered from paraesthesia of the left foot lasting for 3 days. Forty (19%) mothers complained of non-postural headache and 28 (13%) of new-onset back pain. Three mothers (1%) would not want to receive a further spinal block. CONCLUSION: Transient neurologic symptoms (TNSs) after spinal block occurred infrequently. The incidence of PDPH was higher than in the obstetric population in general and calls for re-evaluation of our spinal block methods. Despite the occurrence of neurologic sequelae, patient acceptability was high. SN - 0001-5172 UR - https://www.unboundmedicine.com/medline/citation/16045665/Postpartum_neurologic_symptoms_following_single_shot_spinal_block_for_labour_analgesia_ DB - PRIME DP - Unbound Medicine ER -