Anaes · Neuraxial anaesthesia

Neuraxial anaesthesia

Also known as Spinal anaesthesia · Epidural anaesthesia · Central neuraxial block · CSE · NAP3

Neuraxial anaesthesia — the spinal, the epidural and the combined spinal-epidural — produces a reversible blockade of the spinal nerve roots and the spinal cord by the injection of a local anaesthetic (with or without an adjuvant) into the subarachnoid space (the spinal) or the epidural space (the epidural). The framework rests on four exam-critical ideas: the differential block (sympathetic fibres first, motor last — taught anchor); the hypotension of the sympathetic block, prevented by co-load and vasopressor infusion (phenylephrine guideline-endorsed; noradrenaline and metaraminol preferable to ephedrine in the 55-trial network meta-analysis); the rare but devastating compressive complications — haematoma and abscess — quantified by NAP3 (4.2 per 100,000 pessimistic, 2.0 optimistic) and the UK obstetric surveillance study (1.97 and 3.61 per million maternities); and the ASRA anticoagulant timing that prevents the haematoma. Built on the NAP3 national audit (Cook 2009), the ASRA anticoagulation guideline (Horlocker 2010), the obstetric haematoma/abscess study (Tunn 2025), the vasopressor network meta-analysis (Singh 2026), the intrathecal-morphine hypoxia cohort (Ladha 2017), the blood-patch Cochrane review (Boonmak 2010), the phenylephrine-versus-ephedrine systematic review (Lee 2002), the spinal-hypotension review (Ferré 2020), the intrathecal dose-response trial (Palmer 1999), the PDPH review (Sachs 2014), and the intrathecal-spread review (Pitkänen 2003).

Checked against its sources on 11 Sept 2026