Neuraxial Blockade Research Articles

UK National Reports: Lessons for Obstetric Anaesthesia

The Confidential Enquiries into Maternal Deaths is a national programme investigating maternal deaths in the UK and Ireland and has been running since 1957. Since the inception of the report, there has been a fall in overall maternal deaths, with rates in the UK having fallen from 90 per 100,000 women giving birth in the 1950s to around 10 per 100,000 today. The National Audit Projects are a programme of investigations that study an important subject within anaesthesia, which occurs with a low incidence and is likely to have been incompletely studied previously. There have been five completed National Audit Projects to date, with the latter three providing valuable insights into the serious complications of central neuraxial blockade, airway management and accidental awareness under general anaesthesia. Recommendations from the Confidential Enquiries into Maternal Deaths and the National Audit Projects have led to substantial changes in practice and improved patient safety and outcomes in obstetric anaesthesia in the UK.

Neuraxial Blockade for Cesarean in a Patient with Severe Primary Pulmonary Hypertension, Tricuspid Insufficient and Right Heart Failure: Case Report

Neuraxial Blockade for Cesarean in a Patient with Severe Primary Pulmonary Hypertension, Tricuspid Insufficient and Right Heart Failure: Case Report

Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review.

To compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies. An extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms "ephedrine and phenylephrine," "preterm and term and spinal hypotension," "preeclampsia and healthy parturients," or "multiple and singleton gestation and vasopressor." Society of Obstetric Anesthesia and Perinatology meeting abstracts for the past 4 years were also searched for relevant studies. Both phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use. From the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency.

A national survey of neurological monitoring practice after obstetric regional anaesthesia in the UK.

Neuraxial anaesthesia is widely used in obstetrics and neurological complications are rare. However, when they occur, subsequent investigation and management are time-critical and correlate with the extent of neurological recovery. The Third National Audit Project recommended the implementation of guidelines in obstetric epidural management, including advice on monitoring for early signs of problems and acting upon concerns. However, no national guideline exists for postoperative management in the obstetric population. We conducted a national survey of monitoring after obstetric neuraxial blockade and the management of an abnormally prolonged block. We received responses from 112/189 (59.3%) obstetric anaesthetic leads invited to participate. We determined that post-neuraxial blockade monitoring in the UK is highly variable: only 63/112 (56.3%) respondents' units had a monitoring policy in place, although most of these did not undertake formal neurological monitoring, and a range of different monitoring methods and schedules were employed. In 12/63 (19%) local policies, the first review of neurology was performed at the standard postoperative visit the following day, and 66/112 (58.9%) units had no protocol in place to address emergency management of abnormally prolonged neuraxial blockade. Where a policy was in place, the initial recommended action and the type of imaging used were variable.

Incidence of Maternal Desaturation among Patients Undergoing Elective Caesaraen Section under Regional Anaesthesia

This was a prospective observational study to identify the incidence and possible risk factors for maternal desaturation following neuraxial blockade for elective caesarean section (CS). Patients with body mass index (BMI) ≥ 30 kg/m2 at the first antenatal consultation were identified and classified into the obese group. Neuraxial blockade in the form of subarachnoid block (SAB) or combined spinal-epidural (CSE) was performed. Mean arterial pressure (MAP) and oxygen saturation (SpO2) were recorded at baseline and at 5-minute intervals following neuraxial blockade. Desaturation, defined as SpO2 < 94% for more than 30 seconds without artifacts, was managed with oxygen therapy and other appropriate measures. Newborn Apgar score and umbilical cord blood gases were analysed. Among a total of 254 recruited patients, 69 (27.2%) were obese and were associated with significantly higher age, parity, previous CS and pre-existing diabetes mellitus. The incidence of oxygen desaturation was 1.2%, involving three patients in the non obese group. These desaturation episodes were short-lived and associated with intraoperative hypotension. Six patients, two of whom in the obese group, received rescue oxygen therapy following intraoperative events such as deteriorating SpO2 or hypotension. The mean MAP was significantly lower at baseline and at 5 minutes post neuraxial blockade in the non obese group, which could account for the occurrence of desaturation in this group only. There were no significant inter-group differences in terms of neonatal outcome, umbilical cord blood gases and changes in mean SpO2 post neuraxial blockade. In conclusion, the current practice of not routinely giving supplementary oxygen to patient during elective CS at our institution is deemed to be safe, provided continuous SpO2 monitoring is available throughout the surgery. Further randomised clinical trials are indicated to investigate the impact of maternal obesity and of labouring patients presenting for urgent or emergency CS on intraoperative oxygen desaturation.

Optimal Point of Insertion and Needle Angle in Neuraxial Blockade Using a Midline Approach: A Study in Computed Tomography Scans of Adult Patients.

Neuraxial blockade using a midline approach can be challenging. Part of this challenge lies in finding the optimal approach of the needle to its target. The present study aimed at finding (1) the optimal point of insertion of the needle between the tips of 2 adjacent spinous processes and (2) the optimal angle relative to the skin at which the needle should approach the epidural or subarachnoid space. A computer algorithm systematically analyzed computed tomography scans of vertebral columns of a cohort of 52 patients. On midsagittal sections, the possible points of insertion of a virtual needle and the corresponding angles through which the epidural or subarachnoid space can be reached were calculated. The point chosen to introduce the needle between 2 adjacent spinous processes determines the range of angles through which the epidural or subarachnoid space can be reached. At the thoracic interspaces 1-2 through 3-4, thoracic interspaces 5-6 through 9-10, and at the lumbar vertebral interspaces 2-3 through 4-5, the optimal point of insertion is slightly inferior to the point halfway between the tips of the spinous processes. For thoracic interspace 4-5, the optimal point of insertion is slightly superior to the point halfway between the tips of the spinous processes. For the other interspaces, the optimal point of insertion is approximately halfway between the tips of the spinous processes. The optimal angle to direct the needle varies from 9 degrees at the thoracolumbar junction and at the lumbar interspaces 3-4 and 4-5, to 53 degrees at the thoracic interspace 7-8. Our study has resulted in practical suggestions-based on accurate, reproducible measurements in patients-as to where to insert the needle and how to angulate the needle when performing neuraxial anesthesia using a midline approach.

Barriers for labour analgesia in South India - Knowledge and attitude of relevant stakeholders: A hospital-based cross-sectional study.

Labour pain is both exciting and painful for every woman. Various methods are available to alleviate this pain and help the woman to remember the thrilling moments of her life. A study shows that in India, the average incidence and practice of labour analgesia is only 11%.[1] The dominant question is how many of the Indian women have a pleasant experience of labour as compared to their western counterparts. The main objective of this study was to assess the knowledge and attitude of pregnant women, interns, obstetricians and anaesthesiologists about labour analgesia and to identify the barriers for widespread utilisation of labour analgesia in South India.[2]

Insights into the Roles of Midazolam in Cancer Therapy.

With its high worldwide mortality and morbidity, cancer has gained increasing attention and novel anticancer drugs have become the focus for cancer research. Recently, studies have shown that most anesthetic agents can influence the activity of tumor cells. Midazolam is a γ-aminobutyric acid A (GABAA) receptor agonist, used widely for preoperative sedation and as an adjuvant during neuraxial blockade. Some studies have indicated the potential for midazolam as a novel therapeutic cancer drug; however, the mechanism by which midazolam affects cancer cells needs to be clarified. This systematic review aims to summarize the progress in assessing the molecular mechanism of midazolam as an anticancer agent.

Identification of Lumbar Intervertebral Space: Palpation versus Ultrasound Technique among Obese Subjects

Accurate identification of the intervertebral space (IVS) is necessary during central neuraxial blockade, especially in spinal anaesthesia, to avoid untoward spinal cord injury. Ultrasound guided examination has been shown to be more accurate compared to palpation, but these studies were performed on subjects of various body weights. We conducted our prospective observational study on obese subjects and compared the performance by anaesthesiologists of various levels of anaesthetic experience. Obese subjects with body mass index (BMI) ≥ 30 kg/m2 scheduled for elective surgery were recruited following explanation and written consent. With the subjects in the sitting position, an investigator located the L3-L4 IVS by ultrasound and used an invisible ultraviolet marker pen to mark the upper border, lower border and midpoint (“Point M”) of the space. Two anaesthesiologists of varying levels of experience, categorized as Performer 1 and Performer 2, then located the L3-L4 IVS by palpation. The distance between this point and Point M was measured and recorded. Thirty-two subjects with mean BMI 35.4±6.0 kg/m2 were recruited. The mean intervertebral distance at L3-L4 on ultrasound was 1.5 cm [range 1.2-1.8 cm]. By palpation, the L3-L4 IVS was correctly identified by 56.3%, while a higher IVS was mistaken to be L3-L4 by 23.4% of all performers. The space was correctly identified by 50% of junior anaesthesiologists and 62.5% of the senior counterparts. There was fair agreement between the two categories, with kappa = 0.375 and p = 0.028. In conclusion, there was a sizeable discrepancy between the anaesthesiologists’ estimation by palpation and the actual location of the L3-L4 IVS by ultrasound among obese subjects. This observation was in fair agreement among anaesthesiologists of various levels of anaesthetic experience. The ultrasound-guided technique is useful for better identification of lumbar IVS especially in obese subjects.

Electron Microscopy of Dural and Arachnoid Disruptions After Subarachnoid Block.

It has been customary to attribute postdural puncture headache (PDPH) incidence and severity to size and nature of the dural hole produced during major neuraxial blockade or diagnostic dural puncture. Needle orientation in relation to the direction of dural fibers was thought to be of importance because of the propensity for horizontal bevel placement to cause cutting rather than splitting of the dural fibers. In vitro punctures of stringently quality-controlled human dural sac specimens were obtained with 27-gauge (27G) Whitacre needle (n = 33), with 29G Quincke used parallel to the spinal axis (n = 30), and with 29G Quincke in perpendicular approach (n = 40). The samples were studied with a scanning electron microscope, and the perimeter, appearance, and area (%) of the lesion were calculated. When using small 27G to 29G needles, neither needle tip characteristics nor needle orientation had a substantial bearing on the damage to dural fibers in the dural lesion. Of ultimate importance was the characteristic and size of the hole in the arachnoid. Arachnoid layer lesions produced by different types of spinal needles were not markedly different. Accepted theories of the etiology of PDPH need to be revised. This article marks the first time that arachnoid layer damage has been quantified. Dural fibers tend to have sufficient "memory" to close back the hole created by a spinal needle, whereas arachnoid has diminished capacity to do so. The pathogenesis of PDPH and its resolution algorithm are a far more complex process that involves many more "stages" of development than hitherto imagined.

Evaluation of two different dosages of local anesthetic solution used for ultrasound-guided femoral nerve block for pain relief and positioning for central neuraxial block in patients of fracture neck of the femur

Introduction: Surgical management of the fracture femur is preferred so as to prevent complications associated with prolonged immobilization. Central neuraxial blockade (CNB) is an attractive option for these patients, and an optimal positioning of the patient is a definite requirement. Owing to the pain associated with movement of the fractured limb, it becomes difficult for the patients to give suitable positioning. Femoral nerve block (FNB) features as a rescue analgesia so as to provide adequate analgesia for facilitation of satisfactory positioning. Aim: This study aims to compare analgesic effect of two different dosages of local anesthetic (LA) solution administered for ultrasonography (USG)-guided FNB given to facilitate optimal positioning for conduct of CNB. Materials and Methods: After taking permission from the institutional review board, eighty patients were enrolled in the study to find out the efficacy of dosage of LA solution for FNB in providing pain relief caused by movement of fractured limb during conduct of regional anesthesia. Informed consent was taken. All patients were given USG-guided FNB. Patients were randomized using a computer-generated random number table, into two groups of forty patients each. Group A patients received USG-guided 12 ml of LA solution containing 10 ml lignocaine solution without preservative (2%) plus 2 ml normal saline (NS), while Group B patients received USG-guided 15 ml of LA solution containing 13 ml lignocaine solution without preservative (2%) plus 2 ml NS for positioning before combined spinal epidural. Results: A total of eighty patients, divided randomly into two groups, were enrolled in the study. Demographics (age, sex, weight, and American Society of Anesthesiologists grades) were similar in both groups. No statistical significance was found in the numeric rating scale scores at baseline, zero minutes, 5, and 15 min in both the groups. Conclusion: USG-guided FNB with 12 ml of LA solution was as effective as 15 ml of LA solution for achieving adequate pain relief so as to give optimal positioning for CNB in patients of fracture neck of femur.

Influence of Anaesthesia on Mobilisation Following Hip Fracture Surgery: An Observational Study: 麻醉技術對髖部骨折病人術後活動能力的影響：一項觀察性研究

BackgroundAnaesthetic technique can influence mortality and morbidity following hip fracture surgery. However, its influence on postoperative mobilisation is not clear. In this study, we evaluated the influence of anaesthetic technique on postoperative mobilisation. MethodsIn this prospective observational study, we included all consecutive patients who underwent surgery for hip fracture between 1 January 2012 and 31 December 2013 at our institution. Any patients who died prior to mobilisation or who could not be followed up after surgery were excluded. Data was collected on demographics, clinical characteristics, anaesthesia technique and surgical factors, and date and time of admission, operation, first mobilisation and discharge. ResultsOf the 1040 patients included in the analysis, 264 received general anaesthesia only (Group GA), 322 received general anaesthesia with regional anaesthesia (Group GARA), and 454 received central neuraxial blockade anaesthesia with or without sedation (Group CNB). There was no significant difference in age (p = 0.56), sex (p = 0.23), number of comorbidities (p = 0.06), residential status (p = 0.18), time to surgery (p = 0.10) and length of hospital stay (p = 0.30) between the three groups. There was a statistically significant difference in ASA grade (p = 0.01), implant type used (p = 0.04), grade of operating surgeon (p = 0.02) and grade of anaesthetist during surgery (p = 0.004) among the three groups. Patients in Group GARA had a median time-to-first mobilisation of 23.8 hours after surgery, compared to 24.1 hours in Group GA and 24.3 hours in Group CNB. This difference was not statistically significant after controlling for confounding factors (p = 0.45). ConclusionOur results show that anaesthetic technique does not influence time-to-first mobilisation after hip fracture surgery.

Strategy of perioperative

Central and peripheral regional blockade for surgery are the most suitable, pathogenetically reasonable methods than any other pain relief methods. Advantages of regional blockades are implemented in their extension throughout the required post-operative period. It is proven to reduce the frequency of major complications of the circulatory system, respiratory system, and gastrointestinal tract, as well as mortality rates using prolonged epidural analgesia. Unfortunately, the risk of severe hemorrhagic and infectious complications limits the widespread use of neuraxial blockade, so you should not use them at all patients in a row. The strategy of regional anesthesia is not the expansion of the indications for the central blockades, and in choosing the most appropriate for a particular intervention of regional techniques in order to maximize the realization of its benefits and reduction the risk of complications.

Thromboelastography (TEG®) demonstrates that tinzaparin 4500 international units has no detectable anticoagulant activity after caesarean section

BackgroundLow molecular weight heparin is routinely used for thromboprophylaxis in pregnancy and the puerperium. Consensus guidelines recommend waiting 10–12h after administration of a thromboprophylactic dose of low molecular weight heparin before performing a neuraxial block or removing an epidural catheter. Thromboelastography (TEG®) has been reported to be sensitive to the effects of enoxaparin 4h after administration. The purpose of this study was to use TEG to examine coagulation changes in the first 10h after a thromboprophylactic dose of tinzaparin in an attempt to ratify the current consensus guidelines about timing of neuraxial blockade and epidural catheter removal. MethodsTwenty-four women who had undergone caesarean delivery and were classified as low or intermediate risk of thrombosis were recruited. Blood samples were taken before subcutaneous administration of tinzaparin 4500IU, and at 4, 8 and 10h post-dose. Standard TEG analyses were performed using plain and heparinase cuvettes and samples were also sent for laboratory anti-Xa assay. Thromboelastograph profiles were analysed for a low molecular weight heparin effect. ResultsAnalysis revealed no significant differences in R time, K time, alpha angle or maximum amplitude between plain and heparinase samples at any time point. Apart from a small statistically significant (P=0.033) decrease in maximum amplitude of 2.8% (95% CI 0.3 to 5.4%) at 4h, there were no significant changes in coagulation for any TEG parameter. Anti-Xa levels were virtually undetectable in all patients over the 10h period (median 0.00U/mL; range 0.00–0.13U/mL). ConclusionA thromboprophylactic dose of tinzaparin 4500IU had little detectable effect on coagulation as assessed by TEG and anti-Xa assay. These findings support consensus guidelines which state that it is acceptable to perform neuraxial blockade or remove an epidural catheter 10–12h after a thromboprophylactic dose of tinzaparin. Rather than suggesting a lack of anticoagulant activity, the findings indicate that TEG may not have the sensitivity to detect a tinzaparin effect when this dose is used in this patient group.

Neuraxial Anesthesia

Neuraxial anesthesia refers to all forms of central blockade involving the spinal, epidural, and caudal spaces. This is achieved by the administration of local anesthetic solution into the cerebrospinal fluid or into the epidural space, where the spinal nerve roots exist. Neuraxial blockade has a wide range of applications, including surgical anesthesia, postoperative analgesia, chronic pain management, and anesthesia and analgesia for labor and delivery. It is considered to be one of the most effective methods of producing anesthesia and analgesia as it provides completely reversible loss of sensation in the desired area. By minimizing the amount of systemic medications that are needed for pain relief or by avoiding general anesthesia altogether, neuraxial blockade provides many advantages, including decreased respiratory depression and somnolence, increased functional ability, earlier ambulation, and earlier return of bowel function after surgery. However, the performance of neuraxial blockade is not without risk and therefore requires a well-trained anesthesia provider for safe and effective administration, monitoring, and management. A detailed understanding of neuraxial anesthesia allows for safer practice for the practitioner and more informed decision making for the patient.

“What’s the Risk?” Assessing and Mitigating Risk in Cardiothoracic Surgery

“What’s the Risk?” Assessing and Mitigating Risk in Cardiothoracic Surgery

Comparative Study of Tramadol with That of Butorphanol for the Control of Shivering in Patients Undergoing Neuraxial Blockade

Aim: To compare the efficacy of Tramadol with that of Butorphanol for the control of shivering in patients undergoing neuraxial blockade. Materials And Methods: A randomized, double blind study of 60 patients undergoing lower abdominal and lower limb surgery under spinal anesthesia who got shivering during intra operative period up to 60minutes. Out of which 60 patients, who will develop shivering after neuraxial blockade will be randomly allocated to one of the following groups. Each group contains 30 patients. Group I: (Tramadol Group) Patients received tramadol intravenously (50mg) Group II: (Butorphanol Group) Patients received butorphanol intravenously (1mg) Inclusion criteria: ASA Grade I Or II, age 18 to 60 years, weight 30 to 70 kg, lower abdominal and lower limb surgery under spinal anesthesia. Exclusion Criteria: Patients not willing to take part in study, ASA grade >2, significant systemic illness, patients with fever, pregnancy, patients with history of seizure, patient on oral anticoagulant therapy, emergency surgeries, conditions where neuraxial blockade will be contraindicated. Result: Time taken to control Shivering was significantly lower in Group I (Tramadol) as compared to group II (Butorphanol), more patients with higher sedation score with Butorphanol group compared to Tramadol Group, Nausea and vomiting higher in Tramadol Group compared to Butorphanol Group. Conclusion: Tramadol is most rapid acting & effective in control of shivering with neauraxial block without any significant side effects and least reappearance of shivering as compared to Butorphanol.

The Use of Ultrasound Guidance for Perioperative Neuraxial and Peripheral Nerve Blocks in Children: A Cochrane Review.

Objectives were to determine whether the use of ultrasound guidance offers any clinical advantage in the performance of neuraxial or peripheral nerve blocks in children in terms of increasing the success rate or decreasing the rate of complications. We searched the following databases to March 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OvidSP), EMBASE (OvidSP), and Scopus (to January 2015). We included all parallel randomized controlled trials that evaluated the effect of ultrasound guidance to perform a regional blockade technique in children. We assessed the selected studies for risk of bias with the Cochrane collaboration tool. We graded the level of evidence for each outcome according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group scale. We included 20 studies (1241 participants). Ultrasound guidance increases the success rate by decreasing the occurrence of a failed block: risk difference -0.11 (95% confidence interval [CI], -0.17 to -0.05); I 64%; number needed for additional beneficial outcome for peripheral nerve blocks 6 (95% CI, 5-8). The younger the child, the greater the benefit. From 8 studies (414 participants), pain scores at 1 hour in the postanesthesia care unit were reduced when ultrasound guidance was used; however, the clinical relevance of the difference was unclear (equivalent to -0.2 on a scale from 0 to 10). From 8 studies (358 participants), block duration was longer when ultrasound guidance was used: standardized mean difference (SMD) 1.21 (95% CI, 0.76-1.65: I 73%; equivalent to 62 minutes). Here again, younger children benefited the most from ultrasound guidance. Time to perform the procedure was reduced when ultrasound guidance was used for prescanning before a neuraxial block (SMD -1.97; 95% CI, -2.41 to -1.54; I 0%; equivalent to 2.4 minutes) or as an out-of-plane technique (SMD -0.68; 95% CI, -0.96 to -0.40; I 0%; equivalent to 94 seconds). From 2 studies (122 participants), ultrasound guidance reduced the number of needle passes required to perform the block: SMD -0.90 (95% CI, -1.27 to -0.52; I 0%; equivalent to 0.6 needle pass per participant). From 2 studies (204 participants), we could not demonstrate a difference in the incidence of bloody puncture when ultrasound guidance was used for neuraxial blockade, but we found that the number of participants was well below the optimal information size (risk difference -0.07, 95% CI, -0.19 to 0.04). No major complications were reported for any of the 1241 participants. We rated the quality of evidence as high for success, pain scores at 1 hour, block duration, time to perform the block, and number of needle passes. We rated the quality of evidence as low for bloody punctures. Ultrasound guidance seems advantageous, particularly in young children, for whom it improves the success rate and increases block duration. Additional data are required before conclusions can be drawn on the effect of ultrasound guidance in reducing the rate of bloody puncture.

Optimal point of insertion of the needle in neuraxial blockade using a midline approach: study in a geometrical model.

Performance of neuraxial blockade using a midline approach can be technically difficult. It is therefore important to optimize factors that are under the influence of the clinician performing the procedure. One of these factors might be the chosen point of insertion of the needle. Surprisingly few data exist on where between the tips of two adjacent spinous processes the needle should be introduced. A geometrical model was adopted to gain more insight into this issue. Spinous processes were represented by parallelograms. The length, the steepness relative to the skin, and the distance between the parallelograms were varied. The influence of the chosen point of insertion of the needle on the range of angles at which the epidural and subarachnoid space could be reached was studied. The optimal point of insertion was defined as the point where this range is the widest. The geometrical model clearly demonstrated, that the range of angles at which the epidural or subarachnoid space can be reached, is dependent on the point of insertion between the tips of the adjacent spinous processes. The steeper the spinous processes run, the more cranial the point of insertion should be. Assuming that the model is representative for patients, the performance of neuraxial blockade using a midline approach might be improved by choosing the optimal point of insertion.

Survey of external cephalic version for breech presentation and neuraxial blockade use

Study objectiveNeuraxial blockade may increase external cephalic version (ECV) success rates. This survey aimed to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV. Setting and designWe surveyed Society for Obstetric Anesthesia and Perinatology members regarding ECV practice using a 15-item survey developed by 3 obstetric anesthesiologists and tested for face validity. The survey was e-mailed in January 2015 and again in February 2015 to the 1056 Society of Obstetric Anesthesiology and Perinatology members. We present descriptive statistics of responses. ParticipantsOur survey response rate was 322 of 1056 (30.5%). Main resultNeuraxial blockade was used for ECV always by 18 (5.6%), often by 52 (16.1%), sometimes by 98 (30.4%), rarely by 78 (24.2%), and never by 46 (14.3%) of respondents. An anesthetic sensory block target was selected by 141 (43.8%) respondents, and analgesic by 102 (31.7%) respondents. Epidural drug doses ranged widely, including sufentanil 5-25 μg; lidocaine 1% or 2% 10-20 mL, bupivacaine 0.0625% to 0.5% 6-15 mL, and ropivacaine 0.2% 20 mL. Intrathecal bupivacaine was used by 182 (56.5%) respondents; the most frequent doses were 2.5 mg used by 24 (7.5%), 7.5 mg used by 35 (10.9%), and 12 mg used by 30 (9.3%). ConclusionsNeuraxial blockade is not universally offered to facilitate ECV, and there is wide variability in neuraxial blockade techniques, in drugs and doses administered, and in the sensory blockade (anesthetic or analgesic) targeted. Future studies need to evaluate and remove barriers to allow for more widespread use of neuraxial blockade for pain relief and to optimize ECV success rates.