Emery H. McCrory, P. Toledo
May 12, 2021
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Journal
International Anesthesiology Clinics
Abstract
Childbirth is the most common reason for admission to a hospital in the United States. Although most parturients expect an uneventful delivery, 9 of every 10 women who deliver in the US experience a complication during pregnancy or at delivery. One complication that affects nearly 40,000 women each year, and occurs in roughly 0.3% to 2% of all deliveries, is lower extremity nerve injury. Nerve palsies are often attributed to anesthesia and neuraxial blockade, when in actuality, these injuries are most often secondary to intrinsic obstetrical causes. Nerve injury can occur centrally in the brain or spinal cord or in a peripheral nerve. Identifying the patient’s symptoms, and specific deficit, and whether the injury is sensory, motor, or combined, can help distinguish the location of the injury. Managing this complication can be challenging for the clinician as the injury and can have a significant negative impact on a new mother’s postpartum care and discharge to home because ambulation and daily activities may be difficult. Nerve injuries can also pose a significant risk to the newborn, as the caretaker is more prone to falls and may be unable to independently care for the infant. Along with mechanical challenges, there are also emotional concerns. Nerve palsies can be distressing during an already emotional time period for a newmother, as up to 50% to 60% of women experience “baby blues” within the first 2 weeks after childbirth. Given both the mechanical and emotional challenges after a peripartum nerve injury, maternal support is crucial. In addition to ensuring appropriate care for the patient, there are also medicolegal implications for the anesthesia provider. Evaluating closed claims from the Comparative Benchmark System between the years 2005 and 2015, 106 (3.7%) were obstetric anesthesiology cases, and 54% of those were related to maternal nerve injury. Of the 58 nerve injury lawsuits, all of the patients had a neuraxial procedure for their delivery. Although 50% of nerve injuries typically resolve within 6 to 8 weeks, the remainder can take up to a year to resolve, with some becoming permanent.