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Background and Aims Neuropathy following vaginal delivery can result from various factors such as manipulation, lithotomy position, fetal compression, prolonged labor or anesthesia procedures. When a neurological complication occurs in a patient who received regional anesthesia, anaesthesiologists are typically the firsts to be consulted. (1, 2)

Methods A healthy 27-year-old primipara received epidural analgesia for labour. The patient did not report any lower extremity paresthesia, numbness or pain during procedure. Vacuum-assisted delivery was performed due to prolonged expulsion, with occurrence of shoulder dystocia resolved with McRoberts maneuver. 3h post-delivery the epidural catheter was removed, and 11h postpartum, the patient reported hypoesthesia, tingling, numbness and muscle weakness in the right lower limb with difficulty walking. Neurological examination revealed extensor apparatus deficit in the right leg and decreased sensitivity in the territory compatible with L4 dermatome territory. No signs of epidural hematoma or central neurological injury were observed. Prolonged labor was assumed as the etiology of the neuropathy. Treatment included NSAIDs, corticosteroids, vitamins B1, B6 and B12, and a progressive regimen of gabapentin, with close neurological monitoring.

Results Neurological complications from epidural blocks are rare compared to obstetric causes (1). Given the absence of pain or paresthesia during epidural analgesia, technique-related nerve damage seemed unlikely. Prolonged expulsion phase and vacuum use appeared to be more likely contributors to the neuropathy, potentially overlooked due to sensory block.

Conclusions This emphasizes the importance of thorough neurological examination before and after catheter removal. Although neurological complications may arise from regional anesthesia, anaesthesiologists should consider obstetric causes as more prevalent.