Central nerve damage following neuraxial block is a rare but serious complication that can result in significant morbidity. This article discusses the incidence, risk factors, differential diagnosis, and management strategies for nerve injuries occurring after spinal or epidural anaesthesia. The estimated incidence of permanent nerve injury ranges from 1 in 24,000 to 1 in 54,000 cases, with epidural catheterisation posing a higher risk than single-shot spinal anaesthesia. Common causes include direct needle trauma, vertebral canal haematoma, infection (epidural abscess, meningitis), and chemical injury (e.g., chlorhexidine neurotoxicity). Early recognition of red flag symptoms such as motor deficits, bladder or bowel dysfunction, and severe back pain is crucial for timely intervention. MRI is the gold standard for diagnosis, particularly for space-occupying lesions requiring urgent surgical decompression. Prevention strategies include ultrasound guidance, careful patient selection, aseptic technique, and appropriate timing of anticoagulation. Long-term outcomes vary depending on the severity of the initial injury, with adhesive arachnoiditis carrying a poor prognosis. A multidisciplinary approach, including neurology, pain management, and rehabilitation, is essential for optimizing patient recovery and functional outcomes.