Skin antisepsis for central neuraxial blockade | Association of Anaesthetists

Skin antisepsis for central neuraxial blockade

Please note that these guidelines are currently under review and will be updated in due course


The most appropriate and safe antiseptic solution to use on the skin before central neuraxial blockade remains controversial. A survey of consultant obstetric anaesthetists in 2009 revealed a wide range of practice across the UK in terms of both the antiseptic used and its method of application.  

Central neuraxial blocks (CNBs), which include spinal, epidural, combined spinal epidural (CSE), and caudal epidural injections, are commonly practiced regional anesthesia techniques in the perioperative period, for obstetric anesthesia and analgesia, as well as for managing chronic pain.

These guidelines recommend the method of choice for skin antisepsis before central neuraxial blockade. They include but are not limited to: 

  • Chlorhexidine vs povidone iodine 
  • Chlorhexidine: aqueous vs alcoholic 
  • Chlorhexidine: 0.5% vs 2% 
  • Chlorhexidine, alcohol and neurotoxicity 
  • Use of chlorhexidine in children 
  • Allergic reactions to chlorhexidine 
  • Other infection control precautions for CNB 
  • Skin antisepsis for peripheral nerve blocks