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
Respiratory
Paralysis
(Apnea)
Usually because of severe
hypotension leading to
medullary ischemia
OR
Due to high or total spinal

Immediate management:
Intermittent Positive
Pressure Ventilation (IPPV)
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Withdrawn and reinserted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
 Cauda Equina
Syndrome
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
 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
 Prevention:
• Always confirm the position of

Total Spinal needle/catheter by giving a test dose

with lignocaine + adenaline
• Never inject a bolus, always give
drug in increments of 3-5ml
Dura is accidentally punctured by
needle or catheter during injection Treatment:
• Intubate and IPPV with 100% oxygen
• Vasopressor
Large volume (usually 10-20ml of
• Atropine
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
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 :)