This study investigates severe neurological complications following central neuraxial blockades (CNBs) in Sweden from 1990 to 1999. A retrospective analysis was conducted using postal surveys and administrative files from the healthcare system. During the study period, approximately 1,260,000 spinal blockades and 450,000 epidural blockades were administered, including 200,000 for labor pain relief. The study identified 127 complications, including spinal hematoma (33 cases), cauda equina syndrome (32 cases), meningitis (29 cases), epidural abscess (13 cases), and miscellaneous cases (20). Permanent neurological damage was observed in 85 patients. The incidence of complications was higher after epidural blockades (1:25,000) compared to spinal blockades (1:3600), with obstetric patients having a significantly lower incidence (1:200,000). The study highlights the importance of close surveillance and adherence to guidelines for thromboprophylaxis and coagulation disorders to reduce the risk of complications. Osteoporosis is proposed as a previously neglected risk factor.This study investigates severe neurological complications following central neuraxial blockades (CNBs) in Sweden from 1990 to 1999. A retrospective analysis was conducted using postal surveys and administrative files from the healthcare system. During the study period, approximately 1,260,000 spinal blockades and 450,000 epidural blockades were administered, including 200,000 for labor pain relief. The study identified 127 complications, including spinal hematoma (33 cases), cauda equina syndrome (32 cases), meningitis (29 cases), epidural abscess (13 cases), and miscellaneous cases (20). Permanent neurological damage was observed in 85 patients. The incidence of complications was higher after epidural blockades (1:25,000) compared to spinal blockades (1:3600), with obstetric patients having a significantly lower incidence (1:200,000). The study highlights the importance of close surveillance and adherence to guidelines for thromboprophylaxis and coagulation disorders to reduce the risk of complications. Osteoporosis is proposed as a previously neglected risk factor.