Complications and outcomes following central neuraxial anesthesia in a sub-Saharan Tertiary Hospital: The legal implication

Background Complications following central neuraxial anesthesia have led to litigations and claims in developed nations, however, the incidence of litigation is low in our environment. Anesthetist practicing in Nigeria need to be aware that such complications are not uncommon. Aim and objective To determine central neuraxial anesthesia related complications and the legal implications. Method This was a prospective observational study conducted in 821 patients scheduled for surgery under central neuraxial anesthesia from February 2012 to January 2013. The choice of anesthesia depended on the indication and the duration of surgery. Results The observed complications of central neuraxial anesthesia, which may result in litigation included inadvertent high block (22.4%), paresthesia during needle placement (6.2%), inadequate block (3%), failed block (1.2%), and postdural puncture headache (1.15%). Others were seizure (0.1%), meningism (0.1%), persistent pain in the lower limb for 48 hours (0.1%), back pain (0.7%) and cardiac arrest (0.49%); three of the four cardiac arrest died. There was, however, no report of litigation or claim in this study. Conclusion We have demonstrated that complications, which may result in litigation and claim following central neuraxial anesthesia is not a rare occurrence in our institution. However, there was no record of litigation or claim in our review. Anesthetist in Nigeria need to be aware of the legal implication of such complications. When performing blocks, well recognized complications should be discussed before obtaining consent. If any untoward effect occurs, a detailed note of the findings and treatment should be documented for future reference.