- The purpose of these guidelines is to facilitate the management of central neuraxial blocks and to reduce the likelihood of adverse outcomes and complications which may be associated with such blocks.
- Central neuraxial blocks should never be initiated and/or maintained in a facility that does not have facilities to manage and/or prevent the potential complications (e.g., failed neuraxial block, failed intubation, inadequate analgesia, hypotension, respiratory depression, pruritus, vomiting) and to provide general anaesthesia in case of failure of block or total spinal where emergency surgeries become necessary.
- Resuscitation equipment should include, but is not limited to: sources of oxygen and suction, equipment to protect and maintain the airway and perform endotracheal intubation, a means to provide positive pressure ventilation, and drugs and equipment for cardiopulmonary resuscitation. These must be immediately available.
- Ensure pre anaesthesia consultation is done as outlined above and establish that the woman has consented to the procedure.
- Clinical assessment of the patient’s coagulation status and anticoagulant medications is required in all circumstances as many regional analgesic techniques may have serious complications in the presence of a coagulopathy; for example, epidural hematoma, and retroperitoneal hematoma from lumbar plexus blocks. Laboratory investigations should be undertaken where appropriate. However it should be noted that potent antiplatelet medications, direct thrombin inhibitors and anti-factor Xa drugs are of particular concern because their effects are not readily reversible nor always evident on standard coagulation tests.
- Central neuraxial blocks or obstetric analgesia should be done by a medical practitioner, with training and experience in the technique, or trainees under the supervision of such a practitioner. The person has to be able to adequately manage any hemodynamic changes which may occur as a result of administration of the anaesthetic agents used for the blockade.
- Initiation of central neuraxial blocks needs to be undertaken in an environment where all equipment and drugs that are necessary for the management of complications relating to the procedure are available.
- Intravenous access should be obtained prior to commencement of central neuraxial blocks and maintained for the duration of administration of medication for analgesia.
- Initiation of central neuraxial blocks requires appropriate assistance. This assistance may be a nurse, or a suitably trained Anesthetist’s Assistant.
- Suitable Infection control measures must be followed,
- Oxygen should be administered in the presence of sedation.
- A record of the technique, including method, drugs and dose used, complications or problems encountered should be documented in the patient’s medical record by the practitioner.
- Consideration should be given to the availability of a lipid emulsion, which may be effective in resuscitation during circulatory collapse due to local anaesthetic oxicity for use in conjunction with advanced cardiac life support.
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