Rergional Anesthesia: Complications of Spinal and Epidural Anesthesia
Major complications include infection (meningitis, abscess), epidural hematoma, and permanent neurologic injury. Thankfully, these complications are all rare.
Post-dural puncture headache may occur in patients receiving spinal or when an epidural needle punctures the dura. It is more common with epidurals as epidural needles are larger than spinal needles. Treatment may be supportive (pain medications) or may require an epidural blood patch.
Other complications include block failure or partial blockade (more common with epidurals).
Some side effects include:
Hypotension: Occurs in the period following block placement and more common after spinals. Risk factors include pre-existing hypovolemia and rapid injection of large amounts of local anesthetic. Symptoms include presyncope, nausea and vomiting, and potentially shortness of breath. Treat with fluids and phenylephrine or ephedrine. If bradycardia develops, use ephedrine or atropine.
Nausea and vomiting: Frequently associated with hypotension. Symptoms typically resolve with the hypotension. Otherwise, antiemetic medications such as ondansetron and metoclopramide may be given.
Shivering: The etiology is unknown, but more commonly seen with spinals.
Next page: Local Anesthetic Toxicity (LAST)
Previous page: Spinal and Epidural Blockade for Surgical Procedures