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Adverse effects of neuraxial analgesia and anesthesia for obstetrics

Gilbert J Grant, MD
Section Editor
David L Hepner, MD
Deputy Editor
Marianna Crowley, MD


This topic will review prevention and treatment of adverse effects of regional anesthetic techniques when used peripartum.

The relevant anatomy, techniques, indications, contraindications, and physiologic effects of neuraxial analgesia and anesthesia are discussed in more detail separately. (See "Overview of neuraxial anesthesia" and "Neuraxial analgesia for labor and delivery (including instrumented delivery)".)


Local anesthetic systemic toxicity (LAST) results from high plasma drug concentrations. The most common cause is accidental injection of local anesthetic into a blood vessel. The signs, symptoms, and treatment of LAST are shown in a table (table 1). (See "Local anesthetic systemic toxicity".)

Manifestations – Systemic toxicity manifests in the central nervous system (CNS) as tinnitus, disorientation, and (ultimately) seizures; in the cardiovascular system, toxicity manifests as hypotension, dysrhythmias, and cardiac arrest. CNS toxicity typically precedes cardiovascular toxicity; thus, patients may experience cerebral signs without hemodynamic compromise. Bupivacaine toxicity does not necessarily follow this sequence; cardiac toxicity may occur in the absence of obvious CNS toxicity [1].

Risk factors – Systemic toxicity is more common after epidural than after spinal administration because intrathecal drug doses are lower than epidural doses. Nevertheless, the risk of systemic toxicity after epidural labor analgesia is quite low because the drug doses used for analgesia are very low; the risk of systemic toxicity is greater with epidural anesthesia use for cesarean delivery, as higher drug doses are used.

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Literature review current through: Nov 2017. | This topic last updated: Jun 28, 2017.
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