Complications of obstetric regional analgesia: how much information is enough?

Two hundred parturients who had received epidural analgesia during labour (100 in Melbourne, Australia and 100 in London, UK) were asked on the first postnatal day about their sources of antenatal information on pain relief in labour, their awareness of potential complications of epidural analgesia and the level of risk at which they would wish to be informed before consenting to a procedure. Sources of antenatal information were similar in the two countries although more women in Australia received information from an anaesthetist or obstetrician than in the UK, whilst more women in the UK received information from the media than in Australia. Knowledge of risks was also similar although the Australian subjects were more aware of infective complications while those in the UK were more aware of intravascular injection of local anaesthetic; these differences may reflect recent high-profile cases in the two countries. The preferred level of risk at which women wanted to be informed about a complication varied from 1:1 to 1:1,000,000,000 in all three centres. The majority of women considered that the benefits of epidural analgesia outweighed each of the potential complications. Women differ in their requirements for antenatal information about regional analgesia and its complications, with some wanting to know every complication, however rare. Anaesthetists should be flexible in their disclosure of information when obtaining consent for regional analgesia and consider the particular wishes of each patient rather than follow rigid centralised guidelines.