Insertion of an epidural needle or catheter into the epidural space may cause traumatic bleeding into the epidural space with development of a large haematoma leading to spinal cord compression.
Insertion of the epidural needle through an area of infected skin may introduce pathogenic bacteria into the epidural space, leading to serious complications such as meningitis or epidural abscess.
Accidental dural puncture in a patient with raised ICP may lead to brainstem herniation (coning).
The sympathetic blockade produced by epidurals, in combination with low blood volume may cause profound circulatory collapse.
It may be impossible to position correctly or unable to remain still enough to safely insert an epidural.
Such as multiple sclerosis, may be a contraindication, because any new neurological symptoms may be ascribed to the epidural.
Probably relative rather than absolute. This includes aortic stenosis, hypertrophic obstructive cardiomyopathy (HOCM), mitral stenosis and complete heart block. Patients with these cardiovascular abnormalities are unable to increase their cardiac output in response to the peripheral vasodilatation caused by epidural blockade, and may develop profound circulatory collapse which is very difficult to treat.
‘Spines’may make the placement of an epidural technically impossible.
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