Neuraxial procedures and time to recognition of postpartum lower limb sensorimotor deficit in an obstetric cohort: a retrospective cohort study (2013-2022)

Abstract

Introduction: Peripheral nerve injuries after neuraxial anesthesia in obstetric patients are rare but can impact postpartum recovery. The anesthetic requirements for different modes of delivery may influence block density and the timing of neurologic deficit recognition. We hypothesized that the time to recognition of postpartum lower limb neurologic deficits would differ significantly by mode of delivery.

Methods: We conducted a retrospective cohort study over a 9-year period (2013-2022), identifying postpartum patients referred to anesthesiology and/or obstetric internal medicine consultation for lower limb sensorimotor deficit following neuraxial procedure. The primary outcome was time to first recognition of neurologic deficit, stratified by mode of delivery. Secondary outcomes included incidence, time to ambulation, duration of hospitalization, and recovery profile stratified by peripheral nerve injury subtype. Time data were compared between groups using one-way analysis of variance and post hoc pairwise comparisons adjusted for multiple comparisons. All other outcomes were analyzed using descriptive statistics.

Results: Among 61,044 deliveries and 43,861 neuraxial procedures, 74 cases of postpartum peripheral neuropathies were identified, yielding an incidence of 0.17% (1 in 588). The most common diagnoses were lumbosacral plexopathy (37.8%), femoral neuropathy (33.7%), and lateral femoral cutaneous neuropathy (16.2%). Mean ± standard deviation time to first recognition of postpartum deficit was 22.9 ± 18.7 hours, and mean time to first ambulation after delivery was 22.1 ± 18.3 hours. Significantly delayed recognition occurred after intrapartum cesarean compared with spontaneous vaginal delivery (33.6 vs. 15.9 hours; P=0.005). For 92% of patients, only one or two outpatient follow-up visits were needed. The median time to discharge from outpatient follow-up was 29 days.

Discussion: Postpartum peripheral nerve injuries following neuraxial anesthesia are uncommon and, when they occur, are most often associated with favorable recovery. Recognition of lower limb neurologic deficits was most delayed following intrapartum cesarean deliveries. Structured postpartum neuraxial block monitoring, combined with initiatives that encourage early ambulation and patient self-reporting tools may support timely diagnosis, patient counselling and management.

Keywords: Neuraxial anesthesia; Neurological monitoring; Obstetric anesthesia; Peripheral nerve injury; Postpartum neuropathy.