Mobilisation after neuraxial obstetric anaesthesia
Abstract Number: S-36
Abstract Type: Original Research
INTRODUCTION. Early mobilisation, widely thought to be facilitated by central neuraxial anaesthesia (CNA), is recommended as part of prophylaxis against venous thromboembolism in women who have undergone caesarean section (CS) (1). Our aim was to explore the relationship between CNA, duration of motor block and time to mobilisation following obstetric surgical procedures at our hospital. METHODS. Over a two-month period, data was collected on women who underwent CNA (spinal, combined-spinal-epidural (CSE) or epidural top-up) for an obstetric procedure (CS, instrumental delivery, or perineal repair). They were surveyed as part of our routine obstetric anaesthetic follow-up, 24 to 48 hours after the onset of CNA. Data was collected on onset time and method of CNA, reported times of lower-limb motor function return and of mobilisation, and reasons for failing to mobilise after the return of lower-limb function. RESULTS. Interval times were expressed as the median value. All 79 patients surveyed reported the return of lower limb motor function and 66 were mobilising at the time of follow-up. Figure 1 shows interval times for the onset of CNA to return of motor function and for the onset of CNA to ambulation for all CNA techniques combined and separately. The return of motor function to ambulation intervals were 12 and 20 hours where CNA was given out-of-hours (6pm-6am) and during daylight hours (6am-6pm) respectively. The commonest reason for not mobilising at this time was, ‘awaiting urinary catheter removal’ (43%). DISCUSSION. From our data, we identified the time of day that CNA was given and an in-dwelling urinary catheter as contributors to delayed mobilisation after motor function return. We postulate that women who receive CNA out-of-hours and regain motor function during the day have greater encouragement from daytime staff to mobilise. From this work, we have adapted our protocol and educated maternity ward staff on measures to assist early mobilisation - these include catheter removal and ambulation as soon as possible after return of motor function. CONCLUSION. Our survey identified the timing of CNA and urinary catheter removal as factors delaying mobilisation in our obstetric patients. Changes were made to our practice and protocol regarding mobilisation. REFERENCE. (1) National Institute for Health and Clinical Excellence (2011) Caesarean Section. CG132. London: National Institute for Health and Excellence.