Highlighting recovery or spotlighting progression?
A service evaluation of neuraxial recovery in obstetric anaesthesia
Murray L, Swales D, Harrison H
Department of Anaesthesia, Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust

Introduction 

Although serious neurological lesions such as vertebral canal haematoma are rare after obstetric regional analgesia/anaesthesia, early detection is crucial to avoid permanent harm.

The 2020 Association of Anaesthetists/OAA consensus safety guideline regarding neurological monitoring associated with obstetric neuraxial block recommended prompt escalation of care and review by an anaesthetist if a woman was unable to straight leg raise at four hours.[1] 

The idea of defining local neuraxial recovery times (specific to a unit) to support development of a local safety protocol has been raised [2] and was the driver for this service evalua­tion.

Methods

To assess time to recovery after neuraxial regional anaesthesia, we applied a wristband to all eligible, consenting obstetric patients in recovery following neuraxial anaesthesia for a peripartum theatre intervention during the data collection period.

The time and type of last neuraxial anaesthetic intervention was recorded and patients were then asked to document on the wristband the time at which they were first able to straight leg raise before it was removed for data retrieval.

Results 

Data was collected from 67 parturients (September-November 2025)

Spinal recovery time (n=60)

  Mean    4 hrs 9 min

  Median   4 hrs

  Range  

  1 hr 17 min - 7hr 39 min

Epidural recovery time (n=7)

  Mean   2hrs 14 mins

  Median   1hr 15 mins

  Range 

0 hrs - 5 hrs 58 mins

Discussion

Our data shows that only 50% of patients receiving our department’s standard obstetric spinal anaesthesia dose (2.6 mL 0.5% heavy bupivacaine with 300 μg diamorphine) were able to straight leg raise at 4 hours.

In contrast to this finding, 57% of epidural top-up cases (n=4) exhibited limited motor block. Time to straight leg raise recorded in this group ranged from  0 hrs - 1 hr 15 mins.

Next steps 

We will use this data to support the development of a local safety guideline.

This service evaluation has highlighted the importance of picking up the ‘developing or progressive motor impairment’ in addition to the ‘failed resolution’ to support safety netting in those patients who do not develop or have only a short-lived motor block.

References

Publication/presentation of this abstract has been approved by the Trust audit department/Clinical Effectiveness Unit.