The immediate complications of epidural insertion can again be divided into those occurring during and after the procedure.

Complications during insertion

Complications after insertion

The immediate complications of epidural insertion can again be divided into those occurring during and after the procedure.

Complications during insertion

The immediate complications occurring during epidural insertion are essentially the same as those described previously for spinals: inability to site, pain on insertion and vasovagal episodes can all happen and are treated in the same manner.

Complications after insertion

The immediate complications of epidural insertion can again be divided into those occurring during and after the procedure.

Complications during insertion

Complications after insertion

The onset of epidural blockade is generally slower than that of spinals, and the same is generally true of any sympathectomy-induced hypotension or bradycardia seen after epidurals.

However, the most immediately important complications of epidural are those alluded to under 'Testing', i.e. complications of subarachnoid or intravascular placement:

• Injection of an epidural dose of local anaesthetic into the subarachnoid space can result in rapid onset high or total spinal
• Injection of a similar dose intravascularly can cause signs and symptoms of systemic local anaesthetic toxicity: altered sensorium, altered sensation, seizures, reduced or loss of consciousness, cardiac arrhythmias and cardiac arrest. (Note: this can also happen in a delayed manner, secondary to absorption of a toxic dose)

Treatment is covered in the session Block 5b / Neuraxial techniques / Complications of spinals and epidurals.