Safety of neuraxial anesthesia: Evaluation of complications

Research output: PhD ThesisPhd-Thesis - Research and graduation internal


Severe complications of neuraxial anesthesia, such as spinal or intracranial hematoma or abscess, are rare but more common than estimated in past decades. Complications appear in a heterogeneous patient population and together with the rare occurrence, decision making and treatment of complications is based on expert-opinion. The work presented in this thesis is a step towards more evidence-based care of patients with severe complications of neuraxial anesthesia. In part 1 of this thesis the safety of epidural analgesia is discussed by analyzing the risk-benefit ratio for epidural analgesia and the safety of the most widely used epidural drugs. Part 2 provides evidence-based insight on situations that lead to severe complications of neuraxial anesthesia and outcomes of treatment by evaluating patient characteristics, neuraxial block characteristics and treatment strategies. Trends in neuraxial anesthesia practice, key indications, safety measures, safety reporting, and management of complications of epidural analgesia are investigated in the final part, part 3, of this thesis.
What the (non-)anesthesiologist can learn from this thesis:
• Neuraxial anesthesia can be used safely in young and healthy patients; complications are rarely seen in the obstetric population and the consequences of possible complications are often less severe.
• A relatively higher occurrence and worse outcome of complications is reported in perioperative patients with comorbidities.
• The individual presentation of patients with hematoma or abscess after neuraxial block is highly variable.
• First symptoms most often occur when patients are cared for by non-anesthesiologist, non-neurological, or non-neurosurgical healthcare providers. This, combined with the low incidence of serious complications and variable presentation, makes it difficult to recognize these complications as a result of the previous neuraxial anesthetic procedure.
• Increased or prolonged monitoring after neuraxial techniques by an anesthesiologist or acute pain service can be considered in patients with a higher risk of unfavorable sequelae (for instance after failed neuraxial techniques or a bloody puncture in patients with a compromised coagulation system).
• An association between the adversity of outcome and the severity of the initial presentation, and the delay in surgical decompression was seen.
• Besides neuraxial analgesia for obstetric patients, there is a role for neuraxial analgesia in the perioperative patient. However, new and already existing alternatives such as peripheral regional techniques are being optimized together with the evolvement of minimally invasive surgery, resulting in a continuously changing balance between risks and benefits of neuraxial anesthesia in the individual patient.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Amsterdam
  • Hollmann, Markus, Supervisor
  • Kalkman, C. J., Supervisor, External person
  • Lirk, P. B., Co-supervisor
Award date1 Jun 2022
Print ISBNs9789490858711
Publication statusPublished - 2022

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