Neuraxial blockade side effects in obstetrics
Research type
Research Study
Full title
The incidence and severity of side effects following neuraxial blockade in obstetric patients. A prospective subjective questionnaire.
IRAS ID
139453
Contact name
Surbhi Malhotra
Contact email
Research summary
Research Summary:
Neuraxial blockade, which included epidural, spinal and combined spinal epidural (CSE) techniques was commonly used to provide pain relief in labour or anaesthesia for lower segment caesarean section (LSCS) and instrumental delivery (ID). Neuraxial blockade was the first line anaesthetic technique for LSCS as it was considered lower risk than general anaesthesia for the mother and fetus. In 2011-12 34% of women in the United Kingdom had neuraxial blockade during child birth. The common side effects associated with neuraxial blockade were shivering, fever, itching, nausea, vomiting and low blood pressure (which subjectively was experienced as lightheadedness). Anecdotal evidence suggested that these side effects might be very unpleasant for women, however currently there was little data to support these observations. In addition, certain side effects might lead to adverse outcomes for both the mother and baby, such as unnecessary antibiotic administration, un-necessary obstetric intervention (ID and LSCS) and brain injury to the baby.In this study, the study team would ask women in the first two days after delivery to fill out a Questionnaire, which would ascertain if side effects occurred and subjectively how severe they were. The answers would be used to calculate accurately for the first time the frequency at which side effects occurred and to find out how these side effects affected patient experience.
Summary of Results:
Background: The non-harmful side effects of obstetric neuraxial blockade are well documented, but the frequency at which they occur is unclear. Additionally it is not known if maternal satisfaction is affected by the occurrence of such side effects. The lack of this information impedes the process of obtaining informed consent. This study aimed (1) to record the incidence and severity of side effects, and (2) to assess the impact of side effects upon patient satisfaction.
Methods: 644 patients who had neuraxial blockade for labour analgesia or operative delivery completed a standardised questionnaire on the postnatal ward within 48 hours of delivery. They were asked to report any unpleasant symptoms that occurred following neuraxial blockade and to quantify the severity of such symptoms with a visual analogue scale (VAS). They were also asked to indicate their satisfaction with the neuraxial blockade with a VAS3. Data are presented as n (%) or median (IQR). Incidences and severity scores were compared with a Chi square and Kruskall-Wallis tests respectively. The impact of side effects upon patient satisfaction was investigated with a multivariate logistic regression model.
Results: Side effect incidences and severity scores are presented in the Table. The incidences of shivering and pruritus were greater than those of fever, nausea, vomiting and light-headedness (p < 0.001). The severity of shivering was greater than the severity of pruritus (p < 0.001). Patient satisfaction VAS was 99 (80 – 100) mm. Shivering, pruritus and vomiting were independently associated with reduced patient satisfaction (p < 0.05).
Table: The incidence and severity of side effects.
Side effect Incidence Severity (mm)
Shivering 310 (48%) 59 (35 – 80)
Fever 52 (8%) 55 (42 – 70)
Pruritus 359 (56%) 47 (26 – 70)
Nausea 147 (23%) 51 (32 – 70)
Vomiting 60 (9%) 54 (39 – 80)
Light-headedness 183 (28%) 50 (29 – 74)Discussion: Side effects of moderate severity are common following obstetric neuraxial blockade and shivering, pruritus and vomiting have a negative impact upon patient satisfaction. Patients should receive accurate information about non-harmful side effects during the consent process and when possible these unpleasant symptoms should be prevented and treated.
REC name
North of Scotland Research Ethics Committee 1
REC reference
14/NS/0038
Date of REC Opinion
4 Mar 2014
REC opinion
Further Information Favourable Opinion