An independent provider in the Maidstone area

4. Mrs A complains the Trust failed to provide appropriate care during the anaesthetic stage of her hip replacement surgery on 4 February 2025. Specifically, she complains the Trust: • administered the epidural in a way that was extremely painful and traumatic• caused ongoing leg pain and sciatica following the epidural• did not acknowledge that she sustained a head injury during surgery• did not properly investigate or accept responsibility for what happened.

5. Mrs A says the experience has affected her mobility, wellbeing and daily life. She says the Trust dismissed her concerns and did not take responsibility for the harm she believes she suffered.

6. Mrs A wants acknowledgement of harm, accountability from the Trust and a financial remedy to reflect the impact the events have had on her.

7. Mrs A underwent NHS-funded hip replacement surgery at the Trust on 4 February 2025. As part of the procedure, she received a spinal anaesthetic.

8. Following surgery, Mrs A complained about her experience during the administration of the spinal anaesthetic. She said the procedure was painful and traumatic and believes it caused ongoing leg pain and sciatica. She also reported that she noticed a bump and cut to her head after surgery, which she believes occurred while she was in the Trust's care.

9. The Trust investigated Mrs A's concerns. It said there was no evidence that the spinal anaesthetic was administered incorrectly and no evidence of a head injury occurring during surgery or recovery. The Trust also said Mrs A's ongoing symptoms could have causes unrelated to the spinal anaesthetic.

Issue 1 & 2 - administered the epidural in a way that was extremely painful and traumatic & caused ongoing leg pain and sciatica following the epidural

13. Mrs A complains the Trust administered the epidural in a way that was extremely painful and traumatic. Mrs A believes the epidural caused ongoing leg pain and sciatica following her surgery. She says this has affected her mobility and daily life.

14. Mrs A received a spinal anaesthetic rather than an epidural. Spinal anaesthesia is a type of anaesthesia used in surgeries when your care team doesn’t want you to be able to move or feel anything from the belly button down. An epidural is a slightly different type of anaesthesia also administered in the back.

15. Our adviser said there is no national, published guidance on the administration of spinal anaesthesia.

16. The GMC guidance says doctors must provide a good standard of practice and care. It also says doctors must make sure that formal records of their work, including patient records, are clear, accurate, contemporaneous and legible.

17. The records show the anaesthetist documented that the spinal anaesthetic was inserted successfully on the first attempt. Our adviser said this suggests the procedure was straightforward and there were no indications of difficulty during insertion.

18. Our adviser explained there was no indication in the records that the spinal anaesthetic was administered incorrectly or that any complication occurred during insertion. They said that if the spinal needle had contacted a nerve during insertion, it would usually cause an immediate electric shock sensation, known as paraesthesia. There is no record of this in the anaesthetic records and Mrs A did not report such symptoms at the time.

19. The RCOA guidance explains that nerve damage is a recognised but very rare complication of spinal anaesthesia and normally temporary, occurring in fewer than 1 in 25,000 cases. It says if you develop nerve damage after a spinal anaesthetic, you might experience numbness in parts of your body; a sensation of ‘pins and needles’; unusual and painful sensations at the site of the surgery; and/or weakness in one or more muscle groups.

20. There is no indication in the records that Mrs A experienced these complications.

21. Our adviser explained that hip replacement surgery itself is associated with sciatic nerve problems and that sciatica is also commonly associated with underlying back conditions. They said these were more likely explanations for Mrs A's symptoms than the spinal anaesthetic.

22. We appreciate Mrs A remains concerned that the spinal anaesthetic caused her ongoing symptoms. Having considered the clinical records and independent clinical advice, we consider the Trust acted in line with the GMC guidance and provided a good standard of care to Mrs A. We have not seen any indication that the spinal anaesthetic was administered incorrectly or that it caused the symptoms Mrs A describes.

23. Therefore, we have not seen any indication of failings by the Trust in relation to this complaint and we will not consider this further.

Issue 3 – head injury during surgery or recovery

24. Mrs A says she noticed a bump and cut to her head after surgery. She believes she sustained this injury while under the Trust's care.

25. The Trust explained that it reviewed the available records and found no evidence that Mrs A sustained a head injury during surgery or recovery.

26. Our adviser explained that if a patient sustained a significant injury during surgery or recovery, it would be expected practice for this to be documented in the clinical records and for appropriate follow-up action to be taken.

27. The records do not show any evidence of a head injury being recorded during surgery or recovery. She was discharged the day after her surgery on 5 February at around 1:30pm.

28. In her complaint to the Trust, Mrs A said the day after the surgery she noticed a lump and cut on her forehead. Mrs A has provided photographs which show a head injury. These photographs are not date stamped, but they appear to have been taken at home, following discharge.

29. As the records do not show any evidence of a head injury whilst Mrs A was an inpatient, and as the photographs were taken following discharge, we do not have enough evidence to conclude, even on the balance of probabilities, whether the head injury occurred whilst Mrs A was at the Trust or not. We also do not consider there is any further evidence we could obtain to allow us to reach a view on this.

30. We appreciate Mrs A remains concerned that she sustained a head injury while under the Trust's care. Unfortunately, we cannot reach a decision on when or how the head injury occurred. Therefore, as we are not able to reach a satisfactory conclusion on this matter we decline to investigate this further.

Issue 4: Trust's response to Mrs A's concerns

31. Mrs A says the Trust dismissed her concerns and did not take responsibility for what she believes happened during the anaesthetic procedure.

32. Our NHS Complaint Standards say that organisations should thoroughly investigate complaints and give a clear, balanced account of what happened based on established facts.

33. We have considered the Trust's complaint responses alongside the clinical records. We consider that, in line with Our NHS Complaint Standards, the Trust did give a balanced and fair response to Mrs A’s complaint based on the clinical records.

34. As explained above, we have not seen evidence that the spinal anaesthetic was administered incorrectly, and that it caused Mrs A's ongoing symptoms. We have also not been able to conclude that she sustained a head injury during her care. As such, our findings are the same as the Trust’s.

35. Therefore, we consider the Trust acted in line with Our NHS Complaint Standards and we have not seen any indication that the Trust failed to appropriately consider Mrs A's concerns.

36. We are sorry that Mrs A remains unhappy with the care she was provided at the Trust. We appreciate how difficult it must be to have long term mobility issues and how this affects her wellbeing and daily life. We thank her for bringing her concerns to our attention.

1. We have carefully considered Mrs A’s complaint about the Trust. We are sorry to hear about her experience and recognise the distress and upset she says these events caused her.

2. We thank Mrs A for taking the time to bring her concerns to us. After reviewing the available records, relevant guidance, and independent clinical advice, we have not seen any indication of failings in the care provided by the Trust.

3. We appreciate Mrs A’s concerns about her ongoing leg pain, the injury she says she sustained, and the impact these events have had on her wellbeing and daily life. We have not seen any indication that these difficulties resulted from failings by the Trust. Therefore, we will not be taking any further action on this complaint.