Figure 26.1

Neuropraxia algorithm.

(Courtesy of Adam Zermansky, Kirsty MacLennan, Peter Sandbach and Rachel Stoeter.)

Follow-up

Anaesthetic contact with the parturient may occur at any time during the antenatal or peripartum period. Quality of care delivered at each point of contact is important. Patient safety, clinical effectiveness and patient experience have been highlighted as some of the key attributes of quality. Without appropriate follow-up of patients postoperatively, the quality of service provided cannot be evaluated.

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) and The Obstetric Anaesthesia Association (OAA) in the UK recommend that all women who have received regional analgesia, anaesthesia or general anaesthesia be reviewed following delivery. The review provides feedback for the anaesthetic team. This helps to improve the service and maternal satisfaction based on real patient feedback.

The main aims of follow up are to:

Identify issues regarding anaesthetic management
Determine any side effects of the anaesthetic intervention
Determine the quality of the postoperative care rendered to the parturient
Gauge maternal satisfaction.

Most UK hospitals use a postanaesthetic intervention follow-up questionnaire. An example is highlighted in Figure 26.2. Follow up should focus on the quality of analgesia provided, any relevant side effects and whether those could affect the patient’s daily routine (e.g. PDPH, sensory or motor symptoms). A recent study by Nguyen et al. highlighted open questions about follow-up (e.g. how are you feeling?) and specific questioning (do you have any pain at the moment?) might be necessary to identify pain after surgical intervention. All women should feel able to offer constructive criticism about the care they received as this can help guide service improvement. Concerns identified warrant swift senior attention. Clear lines of communication should exist between anaesthetists, obstetricians, midwifery staff, other specialities, e.g. neurology, and the parturient.

Follow-up Proforma (Please tick all that apply)

1) Anaesthetic Interventions

Single Shot Spinal	Epidural	CSE
Intrathecal Catheter	Remifentanil Patient-Controlled Analgesia (PCA) for Labour
General Anaesthesia	Transversus Abdominal Plane Block

2) Mode of Delivery

Vaginal	Vaginal Instrumental
LSCS	Grade of LSCS: 1 2 3 4

3) Quality of Pain Relief in Labour

In Labour	Good Moderate Poor
During Delivery	Good Moderate Poor
Problems Identified
1) Unilateral Block	2) Missed Segments	3) Re-sited

4) Intraoperative Discomfort

None

Mild

Moderate

Severe

5) Postoperative Pain Relief Prescription

Paracetamol

NSAIDS

Oral Opioids (specify)

PCA (specify)

6) Postoperative Pain

None

Mild

Moderate

Severe

7) Side Effects

None

Sore Throat

Nausea

Vomiting

Itching

Headache

1) Post Dural Puncture Headache

2) Other

Neurological Issues

1) Sensory Symptoms

2) Motor Symptoms

3) Urinary Catheter > 24 hours

Others (e.g.: Myalgia/ Untoward Dreams etc.)

8) Critical Care Admission Required: Yes/No

9) Is anaesthetic follow-up in the clinic required: Yes /No (If yes please discuss with consultant)

10) Maternal Satisfaction

Very satisfied

Satisfied

Dissatisfied

Figure 26.2

Suggested questionnaire for follow-up of patients

Most inpatient follow-ups occur 24–36 hours after delivery. Telephonic follow-up may be possible in those discharged early. Community midwives and general practitioners provide support once the parturient has been discharged.

Parturients experiencing the anaesthetic complications in Table 26.5 should be seen in clinic 6–8 weeks following delivery. This enables explanation of events, time for questions and can lead to a discussion about how care could be improved. This may help reduce litigation and improve service delivery.

Table 26.5 Patients to follow up in clinic 6–8 weeks post-delivery

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