Risks

As with any medical procedure, epidural infiltration can also lead to complications. These can be caused by the treating physician as well as by unfortunate coincidences. For example, if the doctor uses a needle to damage a vessel in the area of the spinal column or spinal cord, bleeding may occur.

Depending on the location of the damaged vessel, the blood can enter the cerebrospinal fluid or compartments around the spine. In the event of larger bleedings, the resulting hematomas must be surgically removed. This circumstance would only be a further source of pain for the patient and should therefore be avoided by the doctor as far as possible.

In addition to the blood vessels, numerous nerves run in the lower back area, which could be injured with a needle. Depending on the type of nerve affected, symptoms of varying severity are to be expected. If the doctor hits a peripheral nerve, this can lead to sensory disturbances or motor failure of the muscles.

In the dramatic case of a spinal cord injury, the consequences are much more far-reaching. From harmless insensitivity to pressure and pain in small areas of skin to paraplegia, anything is possible. Admittedly, the doctor has to do some things wrong until it comes to that.

In addition, if the doctor’s needle guidance is imprecise, internal organs such as the kidney and liver can be accidentally punctured and injured. This can lead to functional disorders and bleeding. Such gross mistakes by the doctor are considered gross malpractice and are also very rare.

Since a drug is administered, the danger of an allergy or even anaphylactic shock is always acute.Patients with fever or skin rashes after epidural infiltration should immediately consult a physician to clarify possible complications. At the same time, such symptoms may also indicate a bacterial infection, which may be caused by the procedure. Since the epidural infiltration involves the penetration of the meninges, such an infection can spread to the brain and lead to meningitis.

This can have serious consequences such as cerebral damage. Since the treatment is often monitored with imaging techniques such as X-rays, the patient is exposed to a certain level of radiation, which is, however, quite low thanks to technically advanced equipment and relatively short irradiation times. Side effects of epidural infiltration can include various circulatory symptoms – nausea, dizziness and vomiting.

As a direct effect of the injection of the local anesthetic into the epidural space, numbness and weakness in the patient’s legs may occur, which may last up to several hours after the injection. Therefore, the patient should remain lying down for the time being and not actively participate in traffic. The cortisone used can cause a variety of side effects, but these are unlikely or only expected to be minor, as comparatively small amounts of cortisone are used in epidural infiltration.

Possible side effects caused by cortisone would be weight gain, increase in blood sugar, rise in blood pressure, osteoporosis, Cushing’s syndrome and further shifts in hormone regulation crises, e.g. the sex hormones. In some patients an allergic reaction may occur in the course of epidural infiltration. This can be caused by the cortisone, the local anesthetic or one of the substances in which the medication is dissolved.

Changes in the skin such as redness or itching may be a sign of this. An extreme case would be an anaphylactic shock, a systemic hypersensitivity reaction to one of the substances. In the case of epidural infiltration, there is always the possibility that the needle used for the injection will injure or irritate structures that are located there.

A further complication would be that the injection was not carried out in a sterile environment and the puncture cell would become infected by the entry of bacteria. A worst case scenario could be that bacteria reach the brain and cause meningitis (inflammation of the meninges). If the hard meninges (dura mater) are injured, i.e. if the doctor accidentally pricks too deeply, post-puncture headache may occur.

Patients complain of headaches in the forehead and neck area with further symptoms such as nausea, vomiting, dizziness, neck stiffness and visual disturbances. The reason for this is probably that cerebrospinal fluid (cerebrospinal fluid) leaks through the area where the meninges have been injured, and leads to irritation of the meninges via various mechanisms. An injury to the spinal cord is a rare complication.

It can occur when an epidural infiltration is performed above the second lumbar vertebral body (L2) and the needle is inserted too deeply through the dura mater (hard meninges) and the arachnoid mater (spider skin) into the subarachnoid space (cerebrospinal fluid space). If the local anesthetic is inadvertently injected here as well, there is a risk of spinal anesthesia – i.e. a complete or partial elimination of the spinal cord. This can cause a circulatory collapse, respiratory paralysis and cramps, if the spinal cord is high enough (close to the brain stem).

If a vein in the epidural space is injured, a hematoma (bruise) may develop at the site. This can remain small and without symptoms. An unfavorable case would be that the hematoma presses on the nerve root in the spinal canal and causes the symptoms of paraplegia down from the injury.
However, the development of such a hematoma is very rare.
In addition to vascular injury, peripheral nerves can also be affected by epidural infiltration. This could lead to sensitive failures in the areas of skin that are supplied by the affected nerves.
A further complication would be that the injection was not sterile and the puncture cell would become infected by the entry of bacteria. A worst case scenario could be that bacteria reach the brain and cause meningitis (inflammation of the meninges).
Postpuntional headache can occur when the hard cerebral membrane (dura mater) is injured, i.e. when the doctor unintentionally pricks too deeply.Patients complain of headaches in the forehead and neck area with further symptoms such as nausea, vomiting, dizziness, neck stiffness and visual disturbances.
The reason for this is probably that cerebrospinal fluid (cerebrospinal fluid) leaks through the area where the meninges have been injured, and leads to irritation of the meninges via various mechanisms. An injury to the spinal cord is a rare complication. It can occur when an epidural infiltration is performed above the second lumbar vertebral body (L2) and the needle is inserted too deeply through the dura mater (hard meninges) and the arachnoid mater (spider skin) into the subarachnoid space (cerebrospinal fluid space).
If the local anesthetic is inadvertently injected here as well, there is a risk of spinal anesthesia, i.e. a complete or partial elimination of the spinal cord. This can cause a circulatory collapse, respiratory paralysis and cramps if the spinal cord is at the appropriate height (close to the brain stem).