National Patient Safety Alert issued 2 December 2025
23 December 2025
The Obstetric Anaesthetists’ Association (OAA) acknowledges the National Patient Safety Alert issued by the Department of Health and Social Care on 2 December 2025 regarding a national shortage of licensed and unlicensed epidural infusion bags containing bupivacaine, as well as combinations of local anaesthetic and opioid used across maternity, surgical, and critical care services. Ensuring the safety and effectiveness of pain relief for women in labour remains our highest priority. Epidural services are a critical component of high-quality maternity care, and we recognise that this shortage presents significant operational challenges for NHS organisations.
The OAA fully supports the alert’s clear safety message that the preparation of epidural infusions in clinical areas carries a substantial risk of dosing error and contamination and should only be undertaken as a last resort. Pre-filled epidural infusion bags are well recognised as safer than locally prepared solutions, and we welcome the requirement for organisations to implement a coordinated, multidisciplinary response—led by anaesthesia, pharmacy, maternity, theatres, and medicines safety teams—to ensure the safe introduction of alternative products. A range of alternative licensed and unlicensed epidural infusion bags is being made available nationally, and many hospitals will be able to continue providing epidural analgesia without interruption. Where supply constraints persist, clinicians may need to adjust practice in line with the national alert.
In some settings, alternative local anaesthetic concentrations may be required. The use of higher concentrations of local anaesthetic for labour analgesia is associated with a small increase in motor block and instrumental delivery, and services should consider strategies to mitigate this risk. Units using programmed intermittent epidural bolus (PIEB) techniques may wish to consider reducing bolus doses or temporarily moving to patient-controlled epidural analgesia (PCEA) alone, with overall volume adjustments as appropriate. Any such changes should be locally risk assessed through the required multidisciplinary governance processes.
Women should be reassured that maternity teams across the UK are working closely with pharmacists, procurement specialists, and national clinical leaders to safeguard continuity of care. Where counselling is required, this should be undertaken carefully to inform without causing unnecessary anxiety. Women can be advised that, due to a national shortage of the usual epidural local anaesthetic, an alternative concentration may be used; this remains a safe and effective option for pain relief, with appropriate modifications made to minimise potential side effects.
This shortage coincides with a separate national shortage of diamorphine, commonly used in spinal anaesthesia for caesarean birth in the UK, requiring obstetric anaesthetists to adapt practice by using alternative opioids such as morphine or fentanyl. Together, these shortages highlight the importance of robust and resilient medicines supply chains to support the delivery of safe, high-quality NHS maternity care. The OAA and its members remain committed to supporting services and ensuring that any changes arising from these shortages continue to uphold the highest standards of safety and evidence-based practice for women and their babies.
