{"id":1367,"date":"2023-09-08T16:45:20","date_gmt":"2023-09-08T16:45:20","guid":{"rendered":"https:\/\/www.drseragyoussif.com.au\/?page_id=1367"},"modified":"2025-04-03T14:53:28","modified_gmt":"2025-04-03T04:53:28","slug":"epidural-contraindications","status":"publish","type":"page","link":"https:\/\/www.drseragyoussif.com.au\/?page_id=1367","title":{"rendered":"Epidural Contraindications"},"content":{"rendered":"<div class=\"brz-root__container brz-reset-all brz brz-root__container-page\">\n<section id=\"_lcrnmmyberhsrogyhazjramuyyuvtgndardu\" class=\"brz-section brz-css-1we6aso\">\n<div class=\"brz-section__content brz-section--boxed brz-css-14kudji brz-css-wakj3h\" data-brz-custom-id=\"fefghiuzdobovsbxytcsilcezrzhjbxzqepb\">\n<div class=\"brz-bg\">\n<div class=\"brz-bg-image\"><\/div>\n<\/div>\n<div class=\"brz-container brz-css-i2dkqz\">\n<div id=\"\" class=\"brz-css-ipwmzw brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-1cq918s\" data-brz-custom-id=\"indocjqefdvgknyaukmztcsaffvelswggttn\">\n<div data-brz-translate-text=\"1\">\n<h2 class=\"brz-tp-lg-empty brz-lh-lg-1_4 brz-ls-lg-m_1 brz-fw-lg-400 brz-fss-lg-px brz-fs-lg-36 brz-ft-google brz-ff-comfortaa brz-text-lg-center brz-tp-xs-empty brz-fs-xs-30 brz-fss-xs-px brz-fw-xs-400 brz-ls-xs-m_1 brz-lh-xs-1_4 brz-css-sw_pz\" data-generated-css=\"brz-css-kipax\" data-uniq-id=\"pdxwq\"><span class=\"brz-cp-color2\">Epidural Contraindications<\/span><\/h2>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-ipwmzw brz-wrapper\">\n<div class=\"brz-line brz-line-default brz-css-15ol550\" data-brz-custom-id=\"fceycromjwvyprfqpckiwifkxywlymnrxhco\">\n<hr class=\"brz-hr\"><\/div>\n<\/div>\n<div class=\"brz-row__container brz-css-1jm5kky\" data-brz-custom-id=\"btiykxyqdvebpjjbczoustutyxjlyieohosd\">\n<div class=\"brz-bg\"><\/div>\n<div class=\"brz-row brz-css-65yxcb brz-css-tgv459\">\n<div class=\"brz-columns brz-css-1qjfa3a brz-css-1k7rqea\" data-brz-custom-id=\"htadfttujzeaqwzqisrkcktywvrwfmvrjsty\">\n<div class=\"brz-bg\"><\/div>\n<div class=\"brz-column__items brz-css-x3lfy7\">\n<div class=\"brz-wrapper-clone brz-css-geywwu\">\n<div class=\"brz-d-xs-flex brz-flex-xs-wrap brz-css-zdotrv brz-css-19e9u0f\" data-brz-custom-id=\"\">\n<div class=\"brz-wrapper-clone__item\" id=\"dhgkkeeuvyxzitzsavmnwqxxnzqaicgjcmrz\">\n<div class=\"brz-icon__container\" data-brz-custom-id=\"dhgkkeeuvyxzitzsavmnwqxxnzqaicgjcmrz\"><span class=\"brz-icon brz-span brz-css-6suiue brz-css-bnvhv1\"><\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-ipwmzw brz-css-1xtjn70 brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-1cq918s\" data-brz-custom-id=\"wnyisohryqxvnoiexrhilbknjtxfmpczbnug\">\n<div data-brz-translate-text=\"1\">\n<h4 class=\"brz-tp-lg-heading4 brz-css-z3tru\" data-generated-css=\"brz-css-rpxwj\" data-uniq-id=\"cziho\"><span class=\"brz-cp-color2\">Absolute Contraindications<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-ipwmzw brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-1cq918s\" data-brz-custom-id=\"sojnsrltsmiyvkmpdhbcvdwfqbtaprcavugq\">\n<div data-brz-translate-text=\"1\">\n<ul>\n<li class=\"brz-tp-lg-paragraph brz-css-eOerO\" data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\"><strong class=\"brz-cp-color7\">Patient refusal<\/strong><\/li>\n<li data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\" class=\"brz-tp-lg-paragraph brz-css-kZDNG\"><strong class=\"brz-cp-color7\">Coagulopathy<\/strong><span class=\"brz-cp-color7\">&nbsp;\u2018Blood does not clot normally\u2019<\/span><\/li>\n<\/ul>\n<p class=\"brz-tp-lg-paragraph brz-css-zpgXl\" data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\"><span class=\"brz-cp-color7\">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.&nbsp;<\/span><\/p>\n<ul>\n<li data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\" class=\"brz-tp-lg-paragraph brz-css-pzrO_\"><strong class=\"brz-cp-color7\">Therapeutic anticoagulation<\/strong><\/li>\n<\/ul>\n<p class=\"brz-tp-lg-paragraph brz-css-rveho\" data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\"><span class=\"brz-cp-color7\">As above&nbsp;<\/span><\/p>\n<ul>\n<li data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\" class=\"brz-tp-lg-paragraph brz-css-xZs_L\"><strong class=\"brz-cp-color7\">Skin infection at injection site<\/strong><\/li>\n<\/ul>\n<p class=\"brz-tp-lg-paragraph brz-css-mwGjE\" data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\"><span class=\"brz-cp-color7\">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.&nbsp;<\/span><\/p>\n<ul>\n<li data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\" class=\"brz-tp-lg-paragraph brz-css-n7oeJ\"><strong class=\"brz-cp-color7\">Raised intracranial pressure<\/strong><\/li>\n<\/ul>\n<p class=\"brz-tp-lg-paragraph brz-css-kQami\" data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\"><span class=\"brz-cp-color7\">Accidental dural puncture in a patient with raised ICP may lead to brainstem herniation (coning).&nbsp;<\/span><\/p>\n<ul>\n<li data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\" class=\"brz-tp-lg-paragraph brz-css-oLAwv\"><strong class=\"brz-cp-color7\">Hypovolaemia \u2018low blood voume\u2019<\/strong><\/li>\n<\/ul>\n<p class=\"brz-tp-lg-paragraph brz-css-c_EOR\" data-uniq-id=\"vcxmx\" data-generated-css=\"brz-css-cbjvz\"><span class=\"brz-cp-color7\">The sympathetic blockade produced by epidurals, in combination with low blood volume may cause profound circulatory collapse.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"brz-row__container brz-css-1jm5kky\" data-brz-custom-id=\"unzrirbmtbkrznszkscgaepznwmkjmnsryns\">\n<div class=\"brz-bg\"><\/div>\n<div class=\"brz-row brz-css-65yxcb brz-css-tgv459\">\n<div class=\"brz-columns brz-css-1qjfa3a brz-css-1wdso6j\" data-brz-custom-id=\"lqrunwpifwgpjdoggznxkxossujhepzsumka\">\n<div class=\"brz-bg\"><\/div>\n<div class=\"brz-column__items brz-css-x3lfy7\">\n<div class=\"brz-wrapper-clone brz-css-geywwu\">\n<div class=\"brz-d-xs-flex brz-flex-xs-wrap brz-css-zdotrv brz-css-ww7tpd\" data-brz-custom-id=\"\">\n<div class=\"brz-wrapper-clone__item\" id=\"gnbfzgwyfeebqdoqmpqdvskwxffjkgiqrqzs\">\n<div class=\"brz-icon__container\" data-brz-custom-id=\"gnbfzgwyfeebqdoqmpqdvskwxffjkgiqrqzs\"><span class=\"brz-icon brz-span brz-css-6suiue brz-css-14rfudb\"><\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-ipwmzw brz-css-17s10mt brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-1cq918s\" data-brz-custom-id=\"galtdwxxjyaosrlotipreyjqdcbptnswnyso\">\n<div data-brz-translate-text=\"1\">\n<h4 class=\"brz-tp-lg-heading4 brz-css-wPNPQ\" data-generated-css=\"brz-css-dxbrm\" data-uniq-id=\"autev\"><span class=\"brz-cp-color2\">Relative Contrindications<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-ipwmzw brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-1cq918s\" data-brz-custom-id=\"crhatjemjyrhcheqifkhprjycbjvdlixncuh\">\n<div data-brz-translate-text=\"1\">\n<ul>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-iHjeM\" data-uniq-id=\"wvagz\" data-generated-css=\"brz-css-fzsiw\"><strong class=\"brz-cp-color7\">UnCooperative patients<\/strong><\/li>\n<\/ul>\n<p class=\"brz-bcp-color7 brz-tp-lg-paragraph brz-css-aCAaB\" data-uniq-id=\"hufli\" data-generated-css=\"brz-css-thuru\"><span class=\"brz-cp-color7\">It may be impossible to position correctly or unable to remain still enough to safely insert an epidural.&nbsp;<\/span><\/p>\n<ul>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-jsh6k\" data-uniq-id=\"rhgbi\" data-generated-css=\"brz-css-gphvg\"><strong class=\"brz-cp-color7\">Pre-existing neurological disorders<\/strong><\/li>\n<\/ul>\n<p class=\"brz-bcp-color7 brz-tp-lg-paragraph brz-css-tMvV1\" data-uniq-id=\"ztfuo\" data-generated-css=\"brz-css-tzwle\"><span class=\"brz-cp-color7\">Such as multiple sclerosis, may be a contraindication, because any new neurological symptoms may be ascribed to the epidural.&nbsp;<\/span><\/p>\n<ul>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-j8HHh\" data-uniq-id=\"qppsz\" data-generated-css=\"brz-css-bpwob\"><strong class=\"brz-cp-color7\">Fixed cardiac output states<\/strong><\/li>\n<\/ul>\n<p class=\"brz-bcp-color7 brz-tp-lg-paragraph brz-css-woB0b\" data-uniq-id=\"aijsn\" data-generated-css=\"brz-css-ifwdv\"><span class=\"brz-cp-color7\">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.&nbsp;<\/span><\/p>\n<ul>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-ua1KT\" data-uniq-id=\"wbtor\" data-generated-css=\"brz-css-lzyhp\"><strong class=\"brz-cp-color7\">Anatomical abnormalities of vertebral column<\/strong><\/li>\n<\/ul>\n<p class=\"brz-bcp-color7 brz-tp-lg-paragraph brz-css-q2SfU\" data-uniq-id=\"xplgo\" data-generated-css=\"brz-css-jliny\"><span class=\"brz-cp-color7\">\u2018Spines\u2019may make the placement of an epidural technically impossible.&nbsp;<\/span><\/p>\n<ul>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-tx3eN\" data-uniq-id=\"pvlmu\" data-generated-css=\"brz-css-ipqmn\"><strong class=\"brz-cp-color7\">Prophylactic low dose heparin<\/strong><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"brz-row__container brz-css-1jm5kky\" data-brz-custom-id=\"tiuylkhnzamvjlgwzbaxrozvwrreacgvaacs\">\n<div class=\"brz-bg\"><\/div>\n<div class=\"brz-row brz-css-65yxcb brz-css-tgv459\">\n<div class=\"brz-columns brz-css-1qjfa3a brz-css-1dem9jm\" data-brz-custom-id=\"jtivjttpfujwtrretcgwqjpjashuvupdperd\">\n<div class=\"brz-bg\"><\/div>\n<div class=\"brz-column__items brz-css-x3lfy7\">\n<div class=\"brz-wrapper-clone brz-css-geywwu\">\n<div class=\"brz-d-xs-flex brz-flex-xs-wrap brz-css-zdotrv brz-css-wkfxfx\" data-brz-custom-id=\"\">\n<div class=\"brz-wrapper-clone__item\" id=\"otrvrunpftncldkwpscbyjzbvgddjownuvdt\">\n<div class=\"brz-icon__container\" data-brz-custom-id=\"otrvrunpftncldkwpscbyjzbvgddjownuvdt\"><span class=\"brz-icon brz-span brz-css-6suiue brz-css-hexh5q\"><\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-ipwmzw brz-css-15t35o1 brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-1cq918s\" data-brz-custom-id=\"jeikglytjzzgeqcrkuaadbuniubrsampvttl\">\n<div data-brz-translate-text=\"1\">\n<h4 class=\"brz-tp-lg-heading4 brz-css-eI3GW\" data-generated-css=\"brz-css-dhcll\" data-uniq-id=\"msuwj\"><span class=\"brz-cp-color2\">Epidurals and anticoagulants<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"\" class=\"brz-css-ipwmzw brz-wrapper\">\n<div class=\"brz-rich-text brz-rich-text__custom brz-css-1cq918s\" data-brz-custom-id=\"fxilmhphuaqvpdtjcipymyeoduxbwnfurvsg\">\n<div data-brz-translate-text=\"1\">\n<ul>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-jw6hw\" data-uniq-id=\"zesku\" data-generated-css=\"brz-css-ualld\"><span class=\"brz-cp-color7\">Full oral anticoagulation with warfarin or standard heparin (SH) are absolute contraindications to epidural blockade.&nbsp;<\/span><\/li>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-x9KR6\" data-uniq-id=\"ivmss\" data-generated-css=\"brz-css-peuic\"><span class=\"brz-cp-color7\">Partial anticoagulation with low molecular weight heparin (LMWH) or low dose warfarin (INR &lt;1.5) are relative contraindications.&nbsp;<\/span><\/li>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-ifGmM\" data-uniq-id=\"ymqem\" data-generated-css=\"brz-css-grfsb\"><span class=\"brz-cp-color7\">Minihep (low dose standard heparin (SH), 5,000units bd s\/c is not associated with an increased risk of epidural haematoma. Wait for 4 hours after a dose before performing epidural. Minihep\/SH should not be given until 1 hour following epidural injection. These guidelines also apply for removal of epidural catheters.&nbsp;<\/span><\/li>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-v_buN\" data-uniq-id=\"iuwbw\" data-generated-css=\"brz-css-qsmcy\"><span class=\"brz-cp-color7\">LMWH (&lt;40mg enoxaparin and dalteparin): allow 12hr interval between LMWH administration and epidural; this also applies to removal of epidural catheters.&nbsp;<\/span><\/li>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-dP9Fm\" data-uniq-id=\"msqab\" data-generated-css=\"brz-css-etdoe\"><span class=\"brz-cp-color7\">NSAID&#8217;s (including aspirin) do not increase the risk of epidural haematoma.&nbsp;<\/span><\/li>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-yJRfa\" data-uniq-id=\"wrgkj\" data-generated-css=\"brz-css-gtfii\"><span class=\"brz-cp-color7\">Intraoperative anticoagulation using 5000units i\/v heparin following epidural\/spinal injection appears safe, but careful postoperative observations are recommended. Bloody tap or blood in epidural catheter is controversial. Some teams delay surgery for 12hr, others (if pre-op coagulation normal) delay i\/v bolus of heparin for 1hour.&nbsp;<\/span><\/li>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-rnDny\" data-uniq-id=\"cmpwj\" data-generated-css=\"brz-css-gmykz\"><span class=\"brz-cp-color7\">Fibrinolytic and thrombolytic drugs: avoid epidural block for 24 hrs, check clotting prior to insertion.&nbsp;<\/span><\/li>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-zNQ47\" data-uniq-id=\"nzywg\" data-generated-css=\"brz-css-ltabz\"><span class=\"brz-cp-color7\">Thrombocytopaenia: epidurals are relatively contraindicated below platelet count of 100,000\/mm3.&nbsp;<\/span><\/li>\n<li class=\"brz-tp-lg-paragraph brz-bcp-color7 brz-css-iiJhM\" data-uniq-id=\"vvwsb\" data-generated-css=\"brz-css-qcmrk\"><span class=\"brz-cp-color7\">An epidural haematoma should be suspected in patients who complain of severe back pain a few hours\/days following any central neuraxial block or with any prolonged or abnormal neurological deficit (including. sensory loss, paraesthesiae, muscle weakness and disturbance of bladder control and anal sphincter tone). A high index of suspicion is required, with early orthopaedic or neurosurgical referral for decompression of the haematoma. Even with early recognition, the morbidity of this condition is still very high.&nbsp;<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<p>    <!-- version:1736998882 --><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Epidural Contraindications Absolute Contraindications Patient refusal Coagulopathy&nbsp;\u2018Blood does not clot normally\u2019 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.&nbsp; Therapeutic anticoagulation As above&nbsp; Skin infection at injection site Insertion of the epidural needle&hellip; <a class=\"more-link\" href=\"https:\/\/www.drseragyoussif.com.au\/?page_id=1367\">Continue reading <span class=\"screen-reader-text\">Epidural Contraindications<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"brizy-blank-template.php","meta":{"footnotes":""},"class_list":["post-1367","page","type-page","status-publish","hentry","entry"],"_links":{"self":[{"href":"https:\/\/www.drseragyoussif.com.au\/index.php?rest_route=\/wp\/v2\/pages\/1367","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.drseragyoussif.com.au\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.drseragyoussif.com.au\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.drseragyoussif.com.au\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.drseragyoussif.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1367"}],"version-history":[{"count":5,"href":"https:\/\/www.drseragyoussif.com.au\/index.php?rest_route=\/wp\/v2\/pages\/1367\/revisions"}],"predecessor-version":[{"id":8756,"href":"https:\/\/www.drseragyoussif.com.au\/index.php?rest_route=\/wp\/v2\/pages\/1367\/revisions\/8756"}],"wp:attachment":[{"href":"https:\/\/www.drseragyoussif.com.au\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1367"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}