The Role of Patient Cooperation in Neuraxial Anesthesia
Neuraxial anesthesia, which includes spinal and epidural anesthesia, is commonly used to block pain in the lower body during labor, surgery, and certain medical procedures. While these techniques are highly effective in providing pain relief, their success often depends not only on the skill of the anesthesiologist but also on the cooperation of the patient. Patient cooperation is critical in ensuring the safety, effectiveness, and comfort of neuraxial anesthesia.
Neuraxial anesthesia involves injecting anesthetic agents near the spinal cord, either into the epidural space (in the case of epidural anesthesia) or the subarachnoid space (in the case of spinal anesthesia). The agents block nerve signals from the lower body, allowing for profound pain relief during surgeries or labor. The procedure is technically challenging and requires precise needle placement to avoid complications and achieve the desired anesthetic effects 1,2.
One of the most important aspects of patient cooperation during neuraxial anesthesia is maintaining the correct position during the procedure. The patient must remain still, as even slight movements can cause complications, such as incorrect needle placement, inadequate anesthesia, or even injury to the spinal cord. During epidural anesthesia, patients are often asked to sit on the edge of the bed or lie on their side in a curled position to expose the target area of the spine.
Patients may feel anxious or uncomfortable in these positions, particularly if they are in pain. Across a variety of clinical conditions and cases, patient cooperation allows the anesthesiologist to insert the needle precisely and administer the anesthetic effectively 3–5.
Effective communication between the patient and the healthcare team is also vital. Patients must be informed about the procedure, its benefits, and potential risks. Anxiety or fear can cause muscle tension, which can complicate the procedure. Clear instructions and reassurance can help the patient stay relaxed, making the procedure easier for the anesthesiologist to perform. A calm patient is also more likely to communicate any sensations or discomfort during the procedure, allowing the anesthesiologist to make necessary adjustments 6–8.
In labor, patient cooperation is complicated by pain and contractions. Labor pain is intense, and while epidural anesthesia aims to provide relief, the patient’s ability to communicate their pain levels and remain still during the procedure significantly affects its success. Patients may need to stay still during contractions, which can be challenging. OB anesthesiologists must be highly skilled in epidural anesthesia to streamline patient care.
Mental preparedness is also important. Pregnant patients who are educated about epidural anesthesia and its effects are often more at ease, leading to better cooperation. While some may struggle to stay still during contractions, remaining calm and following instructions can enhance the procedure’s effectiveness and reduce complications 9–11.
Obtaining patient cooperation helps reduce the risk of complications during neuraxial anesthesia, such as dural puncture, bleeding, or nerve injury, which can arise from improper needle or catheter placement. Unexpected patient movement or failure to communicate discomfort can increase the risk of these complications. In general, when patients remain calm and cooperative, the likelihood of these adverse outcomes is greatly reduced 12–14.
References
1. Vo, H. & Berkery, D. An overview of neuraxial anesthesia. American Nurse https://www.myamericannurse.com/an-overview-of-neuraxial-anesthesia/ (2020).
2. Overview of neuraxial anesthesia – UpToDate. https://www.uptodate.com/contents/overview-of-neuraxial-anesthesia.
3. Poots, C. & Chin, K. J. Strategies for successful lumbar neuraxial anaesthesia and analgesia in patients with challenging anatomy. BJA Education 24, 46–56 (2024). DOI: 10.1016/j.bjae.2023.10.006
4. Hegde, H. V. How to achieve optimal position for central neuraxial blocks in patients with lower limb fractures? Saudi J Anaesth 8, 566–567 (2014). DOI: 10.4103/1658-354X.140910
5. Gurunathan, U., Kunju, S. M., Hay, K. E. & van Alphen, S. Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial. BMC Anesthesiology 18, 11 (2018). DOI: 10.1186/s12871-017-0467-3
6. Jlala, H. A., Bedforth, N. M. & Hardman, J. G. Anesthesiologists’ perception of patients’ anxiety under regional anesthesia. Local Reg Anesth 3, 65–71 (2010). DOI: 10.2147/lra.s11271
7. Cyna, A. M., Andrew, M. I. & Tan, S. G. M. Communication skills for the anaesthetist. Anaesthesia 64, 658–665 (2009). DOI: 10.1111/j.1365-2044.2009.05887.x
8. Ursoleo, J. D., Bottussi, A. & Monaco, F. Talk before they sleep: strategies for patient-centred communication in anaesthesiology. British Journal of Anaesthesia 133, 934–939 (2024). DOI: 10.1016/j.bja.2024.08.013
9. Canada, P. H. A. of. Chapter 4: Care during labour and birth. https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-4.html (2018).
10. Coviello, A. et al. Technical aspects of neuraxial analgesia during labor and maternity care: an updated overview. Journal of Anesthesia, Analgesia and Critical Care 5, 6 (2025). DOI: 10.1186/s44158-025-00224-3
11. Statement on Providing Psychological Support for Obstetric Patients. https://www.asahq.org/standards-and-practice-parameters/statement-on-providing-psychological-support-for-obstetric-patients.
12. Statement on Neurologic Complications of Neuraxial Analgesia/Anesthesia in Obstetrics. https://www.asahq.org/standards-and-practice-parameters/statement-on-neurologic-complications-of-neuraxial-analgesia-anesthesia-in-obstetrics.
13. Doelakeh, E. S. & Chandak, A. Risk Factors in Administering Spinal Anesthesia: A Comprehensive Review. Cureus 15, e49886. DOI: 10.7759/cureus.49886
14. Olawin, A. M. & Das, J. M. Spinal Anesthesia. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).