Complications
Blood pressure drop:A possible complication of epidural anesthesia is a drop in blood pressure because the local anesthetic dilates the vessels. This can result in dizziness and discomfort. A drop in blood pressure occurs because, among other things, the sympathetic nerve fibers are normally responsible for the constriction of the blood vessels (vasoconstriction).
During epidural anesthesia, these nerve fibers are blocked. Instead, the “opponent” of the nervous system, namely the parasympathetic nervous system, predominates. As a result, the blood vessels dilate (vasodilation) and blood pressure drops.
As a side effect, overheating and redness of the affected skin areas can be observed. In order to prevent the drop in blood pressure, a fluid supply via the vein can be induced. However, such a situation is usually effectively prevented by continuous blood pressure monitoring and administration of a circulation-supporting agent.
If the dosage is too high and the inhibition of contractions is too strong, it may be necessary for the doctor to order the administration of a contraction-supporting agent or – if the patient is completely anaesthetized – to use suction bell and forceps. Headaches:Headaches are another complication of epidural anesthesia. Headaches after epidural anaesthesia are caused by the smallest, unintentional injury to the hard skin of the spinal cord (lat.
: dura mater). Small amounts of cerebrospinal fluid (lat. : cerebrospinal fluid) can escape and cause the severe, so-called “post-puncture headache”.
Young people are particularly affected. Nowadays, the risk of this side effect can be minimized by using special, thin needles (atraumatic needles). If possible, strict bed rest in a flat supine position after epidural anaesthesia should also be observed.
Restricted mobility: In addition to the sensitive nerve fibers, the motor nerve fibers are also partially blocked. During epidural anesthesia of the lumbar vertebrae, leg or pelvic muscles can be blocked for a short time. Urinary retention: Due to the blockage of the parasympathetic nervous system, in some cases urinary retention can be observed.
Affected persons are not able to empty their bladder for a short period of time despite filling it. In some cases, a urinary catheter must be inserted temporarily to relieve the symptoms. Itching:Many patients suffer from unpleasant itching at the puncture site, especially if opiates have been administered in addition to the local anesthetic.
In rare cases, life-threatening complications can occur during epidural anesthesia. Despite the mostly performed preventive intravenous fluid intake, there is the possibility of a massive drop in blood pressure. In the worst case a circulatory collapse with cardiac arrest can occur.
Particularly at risk are patients with narrowed coronary arteries (acute coronary syndrome) or other heart diseases. If the anaesthetic is accidentally injected into the blood system, seizures or allergic reactions can be observed. If epidural anaesthesia is carried out correctly, the risk of spinal cord injury is virtually eliminated!However, if the spinal cord is injured, there is always the risk of paraplegia.
As a rule, German clinics guarantee optimal, sterile conditions for epidural anaesthesia. If this is not the case, bacteria and viruses can enter the nervous system through the puncture site and cause a possibly life-threatening meningitis. In extremely rare cases, the anesthetist may inadvertently inject the anesthetic through the hard skin of the spinal cord into the spinal cavity.
Such a “total spinal anaesthesia” is a life-threatening condition, which is associated with respiratory and cardiac arrest. Immediate emergency measures must be taken. The concerns of parents-to-be that the drugs administered during epidural anesthesia could harm the child have not yet been clearly confirmed or resolved beyond doubt. To what extent proportions of the active substances administered during epidural anaesthesia can enter the child’s bloodstream and cause negative effects such as a drop in heart rate remains unclear. On the other hand, the reduced tension in the cervix caused by epidural anaesthesia in combination with the pain and contraction inhibition can be considered beneficial for the child in any case.
