{"id":1386,"date":"2023-09-08T17:12:37","date_gmt":"2023-09-08T17:12:37","guid":{"rendered":"https:\/\/www.drseragyoussif.com.au\/?page_id=1386"},"modified":"2025-04-03T14:53:10","modified_gmt":"2025-04-03T04:53:10","slug":"epidural-complications-and-side-effects","status":"publish","type":"page","link":"https:\/\/www.drseragyoussif.com.au\/?page_id=1386","title":{"rendered":"Epidural Complications and Side Effects"},"content":{"rendered":"
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Epidural Complications and Side Effects<\/span><\/h2>\n<\/div>\n<\/div>\n<\/div>\n
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Serious complications may occur with epidural anaesthesia.<\/strong><\/p>\n<\/div>\n<\/div>\n<\/div>\n

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Hypotension<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
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Is the commonest side effect. It is common in labour and Caesarean Section. It is corrected promptly using fluid and medication to contract blood vessels wall. It presents often with nausea, which may occur before a change in blood pressure has even been detected.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Inadvertent high epidural block<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
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An excessively large dose of local anaesthetic in the epidural space may present with hypotension, nausea, sensory loss or paraesthesia of high thoracic or even cervical nerve roots (arms), or difficulty breathing due to blockade of nerve supply to the intercostals \u2018between ribs\u2019 muscles. These symptoms can be very distressing to the patient and in the most severe cases may require induction of general anaesthesia with securing of the airway, while treating hypotension. If the patient has a clear airway and is breathing adequately they should be reassured and any hypotension immediately treated. Difficulty in talking (small tidal volumes due to phrenic nerve \u2018diaphragm nerve\u2019 block) and drowsiness are signs that the block is becoming excessively high and should be managed as an emergency – see total spinal.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Local anaesthetic toxicity<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
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Can also occur as a result of <\/span><\/p>\n

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  • Excessive local anaesthetic in the epidural space <\/span><\/li>\n
  • Inadvertent injection of local anaesthetic into an epidural vein<\/span><\/li>\n
  • Symptoms usually follow a sequence of light-headedness, tinnitus, circumoral tingling or numbness and a feeling of anxiety or “impending doom”, followed by confusion, tremor, convulsions, coma and cardio-respiratory arrest. It is important to recognise these symptoms early, and discontinue the further administration of local anaesthetic drugs. Treatment should be supportive, with the use of sedative\/anticonvulsants when necessary, and cardiopulmonary resuscitation if required.<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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    Total spinal<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
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    Is a rare complication occurring when the epidural needle, or epidural catheter, is advanced into the subarachnoid space without the operator’s knowledge, and an “epidural dose” e.g. 10-20 ml of local anaesthetic is injected directly into the CSF. The result is profound hypotension, apnoea, unconsciousness and dilated pupils as a result of the action of local anaesthetic on the brainstem. The use of a test dose should prevent most cases of total spinal, but cases have been described where the epidural initially appeared to be correctly sited, but subsequent top-up doses caused the symptoms of total spinal. This has been ascribed to migration of the epidural catheter into the subarachnoid space, although the precise mechanism is uncertain.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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    Management of total spinal:<\/strong><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
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    Secure airway, Administer 100% oxygen – Ventilate by facemask and Intubate. Circulation – treat with i\/v fluids and vasopressor e.g. ephedrine 3-6mg or metaraminol 2mg increments or 0.5-1ml adrenaline 1:10 000 as required Continue to ventilate until the block wears off (2 – 4 hours) As the block recedes the patient will begin recovering consciousness followed by breathing and then movement of the arms and finally legs. Consider some sedation (diazepam 5 – 10mg i\/v) when the patient begins to recover consciousness but is still intubated and requiring ventilation.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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    Accidental dural puncture<\/strong><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
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    Is usually easily recognised by the immediate loss of CSF through the epidural needle. This complication occurs in 1-2% of epidural blocks, although it is more common in inexperienced hands. It leads to a high incidence of post dural puncture headache, which is severe and associated with a number of characteristic features. The headache is typically frontal, exacerbated by movement or sitting upright, associated with photophobia, nausea and vomiting, and relieved when lying flat. Young patients, especially obstetric patients, are more susceptible than the elderly. The headache is thought to be due to the leakage of CSF through the puncture site. Basic measures, such as simple analgesics, caffeine, bed rest, fluid rehydration and reassurance are indicated in the first instance, and are often sufficient to treat the headache. Where the headache is severe, or unresponsive to conservative measures, an epidural blood patch may be used to treat the headache. This procedure is effective in treating approximately 90% of post dural puncture headaches. If unsuccessful, the blood patch may be repeated, and the success rate increases to 96% on the second attempt. The blood injected into the epidural space is thought to seal the hole in the dura.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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    Epidural blood patch<\/strong><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
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    Indications: Clinical diagnosis of post dural puncture headache. Sufficiently severe so as to be incapacitating. Unrelieved by 2-3 days of conservative management.<\/span><\/p>\n

    Contraindications: <\/span><\/p>\n