COMPLICATIONS OFSPINAL & EPIDURAL

ANAESTHESIANUR HANISAH ZAINOREN

COMPLICATIONS O

HypotensionMost common complication

Due to sympathetic blockade

Treatment:Prophylactic: preloading with 1-1.5L of

crystalloid

Curative: head low position (15degree)A. FluidsB. Ephedrine (vasopressor)C. Oxygen inhalation

BradycardiaIncidence: 10%Treatment: iv Atropine

Usually because of severe hypotension leading to

medullary ischemiaOR

Due to high or total spinal

Immediate management: Intermittent Positive

Pressure Ventilation (IPPV)

RespiratoryParalysis(Apnea)

Nausea & vomitingDue to hypotension causing central hypoxia

Treatment:• treat hypotension• oxygenation• antiemetics

Cardiac arrestCauses:• Severe hypotension• Total spinal/very high spinal• Local LA toxicity/anaphylaxis

Immediate start CPR

High spinal Or

Total spinalHigh spinal: spinal above the desired level causing problems to the patient

Too high spinal (above cervical) is called as very high or total spinal

Management: Depend on the level of block

Attempt the removal at once

If not possible, get a portable xray and call for neurosurgeon

Bloody tapUsually occurs due to

puncture of the epidural vein

Withdrawn and reinserted

Urinary retentionMost common postoperative complication

Due to blockade of S2,3,4

Catheterization may be required

Postdural Spinal

HeadacheLow pressure headache due to seepage of CSF FROM HOLE CREATED BY SPINAL NEEDLEChange hemodynamic of CSF

Incidence decrease due to use of smaller gauge needle

Clinical features:• Usually presents after 12-24hrs• Usually occipital but can be

frontal• May be associated withpain

neck stiffness• Pain increase on sitting,

relieves on lying down

MeningitisAseptic: chemical

meningitis because of antiseptic solution like

betadine, glove's starch, blood drops transported

with needle

Usually no treatment required

Infective: usually due to staph. epidermidis carried

from skin along with needle

Treament: iv antibiotics

Due to direct injury to nerve fibers by trauma or by LA

Usually seen with continuous spinal with small bore catheters

Clinical features:• retention of urine• Incontinence of feces• Loss of sexual function• Loss of sesation in periaal

region

Cauda Equina Syndrome

Chronic Adhesive

Arachnoiditis

Epidural Hematoma

(Traumatic Spinal)Can results in• Spinal cord ischemia• Paraplegia• Anterior spinal artery

syndrome

Epidural Abscess

Treatment: neurosurgical intervention

COMPLICATIONS OF

EPIDURAL ANAESTHESIA

Inadequate (patchy)

BlockNumerous fibrous bands in epidural space, so drug may not be equally distributed

L5 & S1 segments are the most difficult to be blocked because of their large size

HypotensionLess seen as compared to spinal because action of drug is slow in epidural.

So, body gets time to compensate

Total Spinal

Dura is accidentally punctured by needle or catheter during injection

Large volume (usually 10-20ml of drug is used) of hypobaric solution (plain bupivacaine and lignocaine are slightly hypobaric) is injected in subarachnoid space

Manifestations:• marked hypotension• bradycardia• apnea• dilated pupils • unconsciousness

Prevention:• Always confirm the position of

needle/catheter by giving a test dose with lignocaine + adenaline

• Never inject a bolus, always give drug in increments of 3-5ml

Treatment:• Intubate and IPPV with 100% oxygen• Vasopressor• Atropine

Dural Puncture

Incidence is 1%

If dura is punctured with epidural needle, there are 2 options:

1. Give hyperbaric LA through this needle (convert it to spinal)

2. Remove the needle and give epidural in higher space

Reference:• Short Textbook of Anaesthesia, 5th edition,

Ajay Vadav

Thank you :)