Incidence, risk factors, management and outcomes of high neuraxial block in obstetric anaesthetic practice: a prospective national observational study using the UK Obstetric Surveillance System
Authors' conclusion
Whilst high neuraxial block is rare in UK obstetric practice and generally managed well, directed attention to key aspects of clinical practice may ameliorate the risk.
Study context
- Population
- Maternity care in the UK; high neuraxial block defined as spinal and/or epidural anaesthesia/analgesia requiring ventilatory support and/or CPRreports, 2017–2019
- Participants
- 89 participants
- Outcome
- Incidence of high neuraxial block
Methodological detailsUK Obstetric Surveillance System
- UK Obstetric Surveillance System
Main finding
As reported in the abstract
Incidence of high neuraxial block per 100,000 neuraxial blocks
Overall incidence 14.7/100,000 neuraxial blocks
14.7/100,000
95%CI 11.8–18.0
After spinal anaesthesia
19.6/100,000
95%CI 14.9–25.3
After epidural analgesia or anaesthesia
7.0/100,000
95%CI 4.6–10.1
Observational data: associations, not effects.
Further findings
Preceding anaesthetic intervention
- Single-shot spinal following labour epidural analgesia (most common)
- 43/89
- Of these, after unsuccessful epidural top-up to convert analgesia to anaesthesia
- 37% (16/43)
- Inadvertent dural puncture
- 15/89
Safety
Cardiac arrest, deaths, psychological distress/awareness
- Cardiac arrest
- 6
- Maternal or neonatal deaths
- 0
- Psychologically distressed and/or awareness during tracheal intubation
- 7
Original publication
Incidence, risk factors, management and outcomes of high neuraxial block in obstetric anaesthetic practice: a prospective national observational study using the UK Obstetric Surveillance System. Anaesthesia. Published 24 September 2025. doi:10.
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