Neurological monitoring associated with spinal epidural anaesthesia

Following vascular surgery under spinal-epidural anaesthetic, there was no return of any sensation or motor function in the lower limbs (Bromage score 3) within 4 hours. The block was not monitored in recovery and although ward staff raised concerns, there was a delay in review and a significant delay in undertaking a MR scan (more than 10 hours). The MR scan confirmed a suspected hematomyelia (haemorrhage occurring within the spinal cord) and the patient suffered permanent neurological sequelae.


This case highlights the need for careful monitoring of patients for block regression following spinal epidural anaesthesia, as recommended by the Association of Anaesthetists1 Units should have an SOP for providing access to rapid MRI 24/7 to prevent delays in diagnosis, with its attendant risks for patient safety.



  1. Association of Anaesthetists. Safety Guideline: Safety guideline: neurological monitoring associated with obstetric neuraxial block. , 2020.