Abstract
The traditional contraindications to any form of local anaesthesia that involves plunging a needle into unknown territory are coagulopathy and sepsis, although these are not the only risk factors for spinal haematoma and abscess. For neuraxial blockade in obstetrics, other contraindications might include circulatory disturbance and shortage of staff trained to apply the block or care for the parturient. None of these is absolute and all require some qualification. Many would add lack of consent to this list, but such a constraint applies to any treatment that is offered.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Dahlgren N, Tornebradt K. Neurological complications after anaesthesia. A follow-up of 18 000 spinal and epidural anaesthetics performed over three years. Acta Anaethesiol Scandinav 1995; 39: 872–80
Dickman CA, Shedd SA, Spetzler RF. Spinal epidural hematoma associated with epidural anesthesia; complications of systemic heparinization in patients receiving peripheral vascular thrombolytic therapy. Anesthesiology 1990; 72: 947–50
Tekkok IH, Cataltepe O, Tahta K, Bertan V. Extradural haematoma after continuous extradural anaesthesia. Br J Anaesth 1991; 67: 112–5
Onishchuk JL, Carlsson C. Epidural hematoma associated with epidural anesthesia: complication of anticoagulant therapy. Anesthesilogy 1992; 77: 1221–3
Roscoe MWA, Barrington TW. Acute spinal subdural hematoma: a case report and review of literature. Spine 1984; 9: 672–5
Lao TT, Halpern SH, MacDonald D, Huh C. Spinal subdural haematoma in a parturient after attempted epidural anaesthesia. Can J Anaesth 1993; 40: 340–5
Brougher RJ, Ramage D. Spinal subdural haematoma following combined spinal-epidural anaesthesia. Anaesth Intensive Care 1995; 23: 111–3
Yuen TST, Kua JSW, Tan IKS. Spinal haematoma following epidural anaesthesia in a patient with eclampsia. Anaesthesia 1999; 54: 350–71
Yarnell RW, D’Alton ME. Epidural hematoma complicating cholestasis of pregnancy. Curr Opin Obstet Gynecol 1996; 8: 239–42
Scott DB, Hibbard BM. Serious non fatal complications associated with extradural block in obstetric practice. Br J Anaesth 1990: 64: 537–41
Scott DB, Tunstall ME. Serious complications associated with epidural/spinal blockade in obstetrics: a two year prospective study. International Journal of Obstetric Anesthesia 1995; 4: 133–9
Holdcroft A, Gibberd FB, Hargrove RL, Hawkins DF, Dellaportas CI. Neurological problems associated with pregnancy. Br J Anaesth 1995; 75: 522–6
Paech MI, Godkin R, Webster S. Complications of obstetric epidural analgesia and anaesthesia: a prospective analysis of 10995 cases. International Journal of Obstetric Anaesthesia 1998; 7: 5–11
Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997; 87: 479–86
Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg 1994: 79: 1165–77
Beilin Y., Zahn J., Comerford M. Safe epidural analgesia in thirty parturients with platelet counts between 69 000 and 98 000 mm-3. Anesth Analg 1997; 85: 385–8
Rasmus KT, Rottman RL, Kotelko DM, Wright WC, Stone JJ, Rosenblatt RM. Unrecognized thrombocytopenia and regional anesthesia in parturients: a retrospective review. Obstet Gynecol 1989; 73: 943–6
Hew-Wing P, Rolbin SH, Hew E, Amato D. Epidural anaesthesia and thrombocytopenia. Anaesthesia 1989; 44: 775–7
Ong BY, Littleford J, Segstro R, Paetkau D, Sutton I. Spinal anaesthesia for caesarean section in a patient with a cervical arteriovenous malformation. Can J Anaesth 1996; 43: 1052–8
Horlocker TT, Wedel DJ, Offord KP. Does preoperative antiplatalet therapy increase the risk of hemorrhagic complications associated with regional anesthesia? Anesth Analg 1990; 70: 631–4
Ramanathan J, Sibai BM, Vu T, Chauhan D. Correlation between bleeding times and platelet counts in women with preeclampsia undergoing cesarean section. Anesthesiology 1989; 71: 188–91
Gorton H, Lyons G. Is it time to invest in a thromboelastograph? International Journal of Obstetric Anesthesia 1999; 8: 171–8
Wong CA, Liu S, Glassenberg R. Comparison of thrombelastography with common coagulation tests in preeclamptic and healthy parturients. Reg Anesth 1995; 20: 521–7
Haljamae H. Thromboprophylaxis, coagulation disorders, and regional anaesthesia. Acta Anaesthesiol Scand 1996; 40: 1024–40
Barker P, Callandar CC. Coagulation screening before epidural analgesia in pre-eclampsia. Anaesthesia 1991; 46: 64–7
Bushnell TG. A survey of coagulation screening practices in preeclampsia and low-dose aspirin prophylaxis. International Journal of Obstetric Anesthesia 1994; 3: 13–5
Millar FA, Mackenzie A, Hutchison G, Bannister J. Hemostasis-altering drugs and central neural block. A survey of anesthetic practice in Scotland and the United Kingdom. Reg Anesth 1996; 21: 529–33
De Sweit M, Redman CWG. Aspirin, extradural anaesthesia and the low dose aspirin study in pregnancy (CLASP). Br J Anaesth 1992; 69: 109–10
Horlocker TT, Wedel DJ, Schroder DR, et al. Preoperative antiplatelet therapy does not increase the risk of spinal hematoma associated with regional anesthesia. Anesth Analg 1995; 80: 303–9
Horlocker TT, Heit JA. Low molecular weight heparin: biochemistry, pharmacology, perioperative prophylaxis regimens and guidelines for regional anesthetic management. Anesth Analg 1997; 85: 874–85
Wulf H. Epidural anaesthesia and spinal haematoma. Can J Anaesth 1996; 43: 1260–71
Loo CC, Dahlgren G, Irestedt L. Neurological complications in obstetric regional anaesthesia. International Journal of Obstetric Anesthesia 2000; 9: 99–124
Ballin NC. Paraplegia following epidural analgesia. Anaesthesia 1981; 36: 952–3
Pang D, Wilberger JE. Tethered cord syndrome in adults. J Neurosurg 1982; 57: 32–47
Ngan Kee WD, Jones MR, Thomas P, Worth RJ. Extradural abscess complicating extradural anaesthesia for caesarean section. Br J Anaesth 1992; 69: 647–52
Borum SE, McLeskey CH, Williamson JB, Harris FS, Knight AB. Epidural abscess after obstetric epidural analgesia. Anesthesiology 1995; 82: 1523–6
Kindler C, Seeberger M, Siegmund M, Schneider M. Extradural abscess complicating lumbar extradural anaesthesia and analgesia in an obstetric patient. Acta Anaesthesiol Scand 1996; 40: 858–61
Jenkin G, Woolley IJ, Brown GV, Richards MJ. Post partum epidural abscess due to group B Streptococcus. Clin Infect Dis 1997; 25: 1249
Dhillon AR, Russell IF. Epidural abscess in association with obstetric analgesia. International Journal of Obstetric Anesthesia 1998; 6: 118–21
Dysart RH, Balakrishnan V. Conservative management of extradural abscess complicating spinalextradural anaesthesia for caesarean section. Br J Anaesth 1997; 78: 591–3
Male CG, Martin R. Puerperal spinal epidural abscess. Lancet 1973; is 608–9
Kitching AJ, Rice ASC. Extradural abscess in the postpartum period. Br J Anaesth 1993: 70: 703
Sata S, Sakuragi T, Dan K. Human skin flora as a potential source of epidural abscess. Anesthesiology 1996; 85: 1276–82
Schmitt RM, Rosenkranz HS. Antimicrobial activity of local anaesthetics. Anesthesiology 1989; 71: 988–90
Harding SA, Collis RE, Morgan BM. Meningitis after combined spinal-extradural anaesthesia in obstetrics. Br J Anaesth 1994; 73: 545–7
Cascio M, Heath G. Meningitis following a combined spinal-epidural technique in a labouring term parturient. Can J Anaesth 1996; 43: 399–402
Bouhemad B, Dounas M, Mercier FJ, Benhamou D. Bacterial meningitis following combined spinal-epidural analgesia for labour. Anaesthesia 1998; 53: 290–5
Ready LB, Helfer D. Bacterial meningitis in parturients after epidural anesthesia. Anesthesiology 1989; 71: 988–90
Sansome AJT, Barned GR, Barret RF. An unusual presentation of meningitis as a consequence of inadvertent durai puncture. International Journal of Obstetric Anesthesia 1991; 1: 35–7
Lee JJ, Parry H. Bacterial meningitis following spinal anaesthesia for caesarean section. Br J Anaesth 1991; 66: 383–6
Newton JA, Lesnik IK, Kennedy CA. Streptococcus salivarius meningitis following spinal anesthesia. Clin Infect Dis 1994; 18: 840–1
Phillips BJ, Fergusson S, Armstrong P, Wildsmith JAW. Surgical facemasks are effective in reducing bacterial contamination caused by dsipersal from the upper airway. Br J Anaesth 1992; 69: 407–8
Gibbs RS, Castillo MS, Rodgers PJ. Management of acute chorioamnionitis. Am J Obstet Gynecol 1980; 136: 709–13
Bader AM, Gilbertson L, Kirz L, Datta S. Regional anesthesia in women with chorioamnionitis. Reg Anesth 1992; 17: 84–6
Goodman EJ, DeHorta E, Taguiam JM. Safety of spinal and epidural anesthesia in parturients with chorioamnionitis. Reg Anesth 1996; 21: 436–41
Gershon RY, Manning-Williams D. Anesthesia and the HIV-infected parturient: a retrospective study. International Journal of Obstetric Anesthesia 1997; 6: 76–81
Shapiro HM. Opposer: Epidural blood patch is contraindicated in HIV-positive patients. International Journal of Obstetric Anesthesia 1994; 3: 168–9
Crone L-A L, Conly JM, Storgard C. Herpes labialis in parturients receiving epidural morphine following cesarean section. Anesthesiology 1990; 73: 208–13
Bengtsson M, Nettelblad H, Sjoberg F. Extradural catheter-related infections in patients with infected cutaneous wounds. Br J Anaesth 1997; 79: 668–70
Jackonson KB, Christensen M-K, Carlsson PS. Extradural anaesthesia for repeated surgical treatment in the presence of infection. Br J Anaesth 1995; 75: 536–40
Parekh N, Husaini SW, Russell IF. Caesarean section for placenta praevia: a retrospective study of anaesthetic management. OAA Annual Meeting, Liverpool 1999
Clark SL, Koonings PP, Phelan PP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985; 66: 90
Sabrine A, Lyons G. Placenta praevia, caesarean section and regional anaesthesia. OAA annual meeting, Harrogate 1998
Ringrose DK. Anaesthesia and the antiphospholipid syndrome: a review of 20 obstetric patients. International Journal of Obstetric Anesthesia 1997; 6: 107–11
Ralph CJ. Anaethetic management of parturients with the antiphospholipid syndrome: a review of 27 cases. International Journal of Obstetric Anesthesia 1999; 8: 249–52
Thornton J, Moore M. Opposers: Women who request analgesia in labour should always be given it. International Journal of Obstetric Anesthesia 1995: 40–3
Hampl KF, Heinzmann-Wiedmer S, Luginbuehl I, Harms C, Seeberger M, Schneider MC, Drasner K. Transient neurologic syndrome after spinal anesthesia: a lower incidence with prilocaine and bupivacaine than with lidocaine. Anesthesiology 1998; 88: 629–33
Salmela L, Aromaa U, Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid-diluted lidocaine 50 mg/ml or mepivacaine 40 mg/ml or bupivacaine 5 mg/ml. Acta Anaesthesia] Scand 1998; 42: 765–9
Bromage PR, Benumof JL. Paraplegia following intracord injection during attempted epidural anesthesia under general anesthesia, Reg Anesth Pain Med 1998: 23: 104–7
Mayall MF, Calder I. Spinal cord injury following attempted thoracic epidural (case report). Anaesthesia 1999; 54: 987–8
Phillips BJ, Fergusson S, Armstrong P, Wildsmith JAW. Surgical facemasks are effective in reducing bacterial contamination caused by dispersal from the upper airway. Br J Anaesth 1992; 69: 407–8
Bromage PR. Neurological complications of regional anesthesia for obstetrics. In Shnider SM, Levinson G (eds) Anesthesia for obstetrics. Baltimore: Williams & Wilkins, 1979; 301–11
Rajakulendran Y, Rahman S, Vencat N. Long-term neurological complication following traumatic damage to the spinal cord with a 25 gauge Whitacre spinal needle. International Journal of Obstetric Anesthesia 1999; 8: 62–6
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2000 Springer-Verlag London
About this chapter
Cite this chapter
Reynolds, F. (2000). Contraindications to regional analgesia in labour?. In: Reynolds, F. (eds) Regional Analgesia in Obstetrics. Springer, London. https://doi.org/10.1007/978-1-4471-0435-3_29
Download citation
DOI: https://doi.org/10.1007/978-1-4471-0435-3_29
Publisher Name: Springer, London
Print ISBN: 978-1-4471-1142-9
Online ISBN: 978-1-4471-0435-3
eBook Packages: Springer Book Archive