COMPLICATIONS OF SPINAL & EPIDURAL ANAESTHESIA

All the traumatic complications of spinal anaesthesia are also with the epidural anaesthesia

1. COMPLICATIONS OF SPINAL & EPIDURAL ANAESTHESIA NUR HANISAH ZAINOREN

2. COMPLICATIONS O

3. Hypotension Most common complication Due to sympathetic blockade Treatment: Prophylactic: preloading with 1-1.5L of crystalloid Curative: head low position (15degree) Fluids Ephedrine (vasopressor) Oxygen inhalation

4. Bradycardia Incidence: 10% Treatment: iv Atropine

5. 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)

6. Nausea & vomiting Due to hypotension causing central hypoxia Treatment: treat hypotension oxygenation antiemetics

7. Cardiac arrest Causes: Severe hypotension Total spinal/very high spinal Local LA toxicity/anaphylaxis Immediate start CPR

8. 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

9. Attempt the removal at once If not possible, get a portable xray and call for neurosurgeon

10. Bloody tap Usually occurs due to puncture of the epidural vein Withdrawn and reinserted

11. Urinary retention Most common postoperative complication Due to blockade of S2,3,4 Catheterization may be required

12. 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

13. 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

14. 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

15. Chronic Adhesive Arachnoiditis

16. Epidural Hematoma (Traumatic Spinal) Can results in Spinal cord ischemia Paraplegia Anterior spinal artery syndrome

17. Epidural Abscess Treatment: neurosurgical intervention

18. COMPLICATIONS OF EPIDURAL ANAESTHESIA

19. 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

20. Hypotension Less seen as compared to spinal because action of drug is slow in epidural. So, body gets time to compensate

21. 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

22. Dural Puncture Incidence is 1% If dura is punctured with epidural needle, there are 2 options: Give hyperbaric LA through this needle (convert it to spinal) Remove the needle and give epidural in higher space

23. Reference: Short Textbook of Anaesthesia, 5th edition, Ajay Vadav

24. Thank you :)