Congratulations to Dr Rachel Mathers.
Congratulations to Dr Rachel Mathers for winning January 2022's Letter of the Month prize in Anaesthesia News for her letter on the Regional Anaesthesia Alert Bracelet project she has developed in the Southern Trust.
Recent guidelines state that following obstetric neuraxial block, ‘a woman should be able to straight-leg raise at four hours from her last dose of epidural or spinal’ and that the woman ‘should be informed of this timescale and encouraged to alert staff should this be delayed’ . Vertebral canal haematoma following regional anaesthesia is potentially catastrophic and permanent. Management is time-critical, requiring detection, escalation and surgery within 8 h. To facilitate monitoring, I introduced the ‘Regional anaesthetic alert bracelet’ (RAAB) - a simple patient safety initiative that should detect neurological problems early, and so bring peace of mind to both anaesthetists and postpartum mums alike!
The RAAB was introduced onto the elective caesarean section list first. After surgery, the woman receives a bracelet with her 'unique four hour time' when straight-leg raising is expected (Figure 1). This time is documented by the anaesthetist at WHO checkout together with confirmation of bracelet placement. At this time the woman attempts to straight-leg raise. If successful, she discards the bracelet; if unsuccessful she alerts her midwife who requests an anaesthetic review. The simplicity of the project meant that the RAAB was soon introduced for emergency caesarean sections and labour epidurals, and is now being established in all maternity units in Northern Ireland.
The RAAB has been warmly welcomed by women, with feedback such as “I feel safe with it on” and gives “permission to speak up” if concerned. Many set a ‘four hour time’ alarm on their phones. Others have declared how “pleased and relieved” they are to be able to successfully straight-leg raise at four hours, declaring it their first milestone towards going home with baby! It will be possible to adapt it to other specialities that frequently use regional anaesthesia. Could it be that permanent neurological damage following regional anaesthesia becomes a distant memory?
Acknowledgements: Mark McCague, ST4 Anaesthetic Trainee and Alison Blair, Consultant Anaesthetist.
Rachel Mathers Consultant Anaesthetist and Obstetric Anaesthetic Lead Daisy Hill Hospital, Southern Health and Social Care Trust, Newry
Yentis SM, Lucas DN, Brigante L, et al. Safety guideline: neurological monitoring associated with obstetric neuraxial block 2020. A joint guideline by the Association of Anaesthetists and the Obstetric Anaesthetists Association. Anaesthesia 2020; 75: 913-9."