High Spinal Block in Obstetrics

Pain control in labor is challenging, and multiple modalities are available to help alleviate discomfort. Selection of the optimum modality is based on the assessment of patient comorbidities, fetal health, method of delivery, and patient preferences. Neuraxial analgesia has been shown to be the best option for cesarean section if the patient is an appropriate candidate. Benefits are rapid analgesia, the patient being awake for delivery, and minimal fetal depression. One potential complication for neuraxial analgesia is a high spinal block where the effect of the injection local anesthetic rises above the desired T4 level and causes cardiopulmonary instability. This chapter reviews the signs and symptoms of a high spinal block and the management of fetal bradycardia. In addition, this comprehensive chapter provides an overview of the materials needed to develop and implement a successful simulation, including a case scenario, narrative, and progression, as well as a scoring rubric for the evaluation of high spinal block management.