How UK obstetric anaesthetists assess neuraxial anaesthesia for caesarean delivery: national surveys of practice conducted in 2004 and 2010

Abstract

Background: There is much interest in optimal methods of assessing neuraxial block before caesarean delivery. Although cold sensation is commonly used, some evidence suggests that the risk of intraoperative pain may be reduced by assessing light touch. We aimed to determine how neuraxial anaesthesia was managed perioperatively, and whether changes in clinical practice reflected the differing evidence in the literature over six years.

Methods: A survey was sent to UK consultant OAA members in 2004, asking how neuraxial block was assessed before caesarean delivery, what was documented, what information was given to the patient, and postoperative follow-up. The survey was repeated in 2010.

Results: Compared to all other methods of assessing neuraxial block, ethyl chloride was the most popular in 2004 (71.8%, 95% CI 68.3-75.0, P < 0.0001) and 2010 (74.6%, 95% CI 70.8-78.3, P < 0.0001). There was a non-significant increase in light touch use from 54% to 60.1%. The upper level of block varied with the modality tested. There was a significant increase in respondents testing with light touch to T5.

Conclusions: Methods of assessing neuraxial block differed from those recommended in the literature. The wide range of modalities, methods of testing and targeted sensory levels suggest that clearer recommendations on best practice for assessment and documentation of neuraxial block before caesarean delivery are required.

Keywords: Caesarean delivery; Epidural; Sensory level; Spinal.