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COMPLICATIONS OF
SPINAL & EPIDURAL
ANAESTHESIA
NUR HANISAH ZAINOREN
COMPLICATIONS O
Hypotension
Most common complication
Due to sympathetic blockade
Treatment:
Prophylactic: preloading with 1-1.5L of
crystalloid
Curative: head low position (15degree)
A. Fluids
B. Ephedrine (vasopressor)
C. Oxygen inhalation
Bradycardia
Incidence: 10%
Treatment: iv
Atropine
Usually because of severe
hypotension leading to
medullary ischemia
OR
Due to high or total spinal
Immediate management:
Intermittent Positive
Pressure Ventilation (IPPV)
Respiratory
Paralysis
(Apnea)
Nausea &
vomiting
Due to hypotension causing
central hypoxia
Treatment:
• treat hypotension
• oxygenation
• antiemetics
Cardiac arrest
Causes:
• Severe hypotension
• Total spinal/very high spinal
• Local LA toxicity/anaphylaxis
Immediate start CPR
High spinal
Or
Total spinal
High 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 tap
Usually occurs due to
puncture of the epidural vein
Withdrawn and reinserted
Urinary
retention
Most common
postoperative
complication
Due to blockade of
S2,3,4
Catheterization
may be required
Postdural
Spinal
Headache
Low pressure headache due to
seepage of CSF FROM HOLE
CREATED BY SPINAL NEEDLE
Change 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
Meningitis
Aseptic: 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)
Block
Numerous 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
Hypotension
Less 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 :)

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COMPLICATIONS OF SPINAL & EPIDURAL ANAESTHESIA

Editor's Notes

  1. Treatment: Preventive: needle (small gauge and dura separating) Adequate hydration (promote CSF production) Avoid spinal in ptt with ho headache Curative: lie supine in slight trendelenburg position Analgesics Iv fluid (promote csf production)