Self-reported post-discharge symptoms following obstetric neuraxial blockade.

BACKGROUND: Economic pressures are leading to earlier hospital discharge following delivery, before complications of obstetric neuraxial block may become apparent. Our aim was to estimate the incidence of symptoms presenting post-discharge at a single tertiary obstetric centre. METHODS: From June 2004 to June 2007, a prospective observational study of all women receiving neuraxial block for labour and delivery in our hospital was conducted. Patients were reviewed in hospital by the acute pain team and provided with a discharge advice form to take home to identify potential block-related complications. We collected data on those contacting us with new-onset symptoms after hospital discharge. RESULTS: Ninety-eight patients (1.4%) made contact post-discharge following neuraxial block. The time range overall for presentation of symptoms was 2-260 days, with headache reported significantly earlier than backache. Many symptoms were self-limiting. Headache was the commonest primary complaint in 43 patients (44%) with four receiving an epidural blood patch. Sensorimotor symptoms of pain, paraesthesia or weakness was the primary complaint in 33 patients (34%), and backache in 21 (21%). Sixteen percent of patients with headache, 24% with sensorimotor symptoms and 14% with backache were referred to neurologists. There was a late self-report of obstetric palsy (1:15,033). CONCLUSIONS: New post-discharge symptoms were self-reported by 1.4% of patients following neuraxial blockade. These were not detected during hospital stay despite routine directed post-block review. Only 4% of these symptoms could be directly attributable to neuraxial block.

Epidural fentanyl reduces the shivering threshold during epidural lidocaine anesthesia.

UNLABELLED: Epidural local anesthetics and IV opioids both decrease the core temperature that triggers shivering. However, the effect of epidural opioids on shivering thresholds has not been assessed. In this study, we tested the hypothesis that adding epidural fentanyl to epidural lidocaine decreases the shivering threshold compared with epidural lidocaine alone. Fourteen healthy male patients undergoing extracorporeal shockwave lithotripsy under epidural anesthesia were randomly assigned to receive either epidural lidocaine or epidural lidocaine plus epidural fentanyl. Ice-cold lactated Ringer's solution was given IV before epidural blockade, and the core temperature that triggers shivering was established. Then epidural anesthesia was induced, and the shivering threshold was established again after lithotripsy. Results were analyzed using paired or unpaired t-tests. Reduction in the shivering threshold by epidural anesthesia was significantly greater when fentanyl was added to lidocaine than when lidocaine was used alone (mean +/- SD: -0.6+/-0.4 degrees C versus -0.1+/-0.4 degrees C; P < 0.02). We conclude that patients are at increased risk of hypothermia when fentanyl is added to epidural lidocaine. IMPLICATIONS: Fentanyl is often added to lidocaine to improve the quality of epidural blockade and to reduce side effects. However, this study shows that patients are at increased risk of hypothermia when fentanyl is added to lidocaine.