FAB for CNB

The BJA in "Advanced Access" publishes Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. In brief, its conclusions are reassuring. The absolute risk of CNB is low, but is relatively higher for perioperative use compared to obstetric use. In obstetrics, the risk of a major complication of CNB is extremely low, but curiously (and unsurprisingly!) CSE is given a higher rate compared to both spinal and epidural. In the perioperative group, spinal is given a much lower rate than both epidural and CSE. This audit sought severe complications. One wonders if less severe, but troublesome complications such as neuropathy and headache have similar comparitive rates of relative risk between the clinical groups and types of CNB.

As a practice implication, for me this report reinforces that epidural alone is the choice technique for a routine request for "an epidural" in labour, and spinal anaesthesia is the choice for routine caesarean section in an uncomplicated parturient. In the perioperative setting, this report reinforces an advantage of intrathecal opioid via a spinal needle compared to epidural catheter infusion of anaesthetic and opioid for postoperative analgesia.