More info about Epidurals

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Complications of epidural use


These include:


Block failure (about 1 in 20). Partial failure may still give satisfactory pain relief. However, if pain relief is inadequate, another epidural may have to be performed.
Bloody tap (about 1 in 30-50). It is easy to injure an epidural vein with the needle. In patients who have normal blood clotting, it is extremely rare (e.g. 1 in 100,000) for problems to develop. However, in a patient who has a coagulopathy, the patient may be at risk of epidural hematoma. If blood comes back down the needle, the anesthesiologist will normally place the epidural at another level.
Accidental dural puncture with headache (common, about 1-3 in 100 insertions[29][30][31]) The epidural space in the adult lumbar spine is only 3-5mm deep, which means it is comparatively easy to cross it and accidentally puncture the dura (and arachnoid) with the needle. This may cause cerebrospinal fluid (CSF) to leak out into the epidural space, which may in turn cause a post dural puncture headache (PDPH). This can be severe and last several days, and in some rare cases weeks or months. It is caused by a reduction in CSF pressure and is characterised by postural exacerbation when the patient raises their head above the lying position. If severe it may be successfully treated with an epidural blood patch (a small amount of the patient's own blood given into the epidural space via another epidural needle which clots and seals the leak). Most cases resolve spontaneously with time.
Catheter misplaced into a vein (uncommon, less than 1 in 300). Occasionally the catheter may be misplaced into an epidural vein, which results in all the anaesthetic being injected intravenously, where it can cause seizures or cardiac arrest[32][33] in large doses (about 1 in 10,000 insertions[31]). This also results in block failure.
High block, as described above (uncommon, less than 1 in 500).
Catheter misplaced into the subarachnoid space (rare, less than 1 in 1000). If the catheter is accidentally misplaced into the subarachnoid space (e.g. after an unrecognised accidental dural puncture), normally cerebrospinal fluid can be freely aspirated from the catheter (which would usually prompt the anaesthetist to withdraw the catheter and resite it elsewhere). If, however, this is not recognised, large doses of anaesthetic may be delivered directly into the cerebrospinal fluid. This may result in a high block, or, more rarely, a total spinal, where anaesthetic is delivered directly to the brainstem, causing unconsciousness and sometimes seizures.
Neurological injury lasting less than 1 year (rare, about 1 in 6,700).[34]
Epidural abscess formation (very rare, about 1 in 145,000).[34] The risk increases greatly with catheters which are left in place longer than 72 hours.
Epidural haematoma formation (very rare, about 1 in 168,000).[34]
Neurological injury lasting longer than 1 year (extremely rare, about 1 in 240,000).[34]
Paraplegia (extremely rare, less than 1 in 100,000).[35]
Arachnoiditis (extremely rare, fewer than 1000 cases in the past 50 years)[36]
Death (extremely rare, less than 1 in 100,000).[35]





Prolonged labour and risk of instrumental deliveryEpidural analgesia is associated with longer labor.[38] Some researchers claim that it is correlated with an increased chance of operational intervention. The clinical research data on this topic is conflicting. For example, a study in Australia (Roberts, Tracy, Peat, 2000) concluded that having an epidural reduced the woman's chances of having a vaginal birth, without further interventions (such as episiotomy, forceps, ventouse or caesarean section) from 71.4% to 37.8%. Conversely, a 2001 study by researchers at the National Institute of Child Health and Human Development and a 2002 study by researchers at Cornell University and the University of Ontario demonstrated that epidurals do not increase the likelihood of a caesarean section. In 2005, a meta-analysis of 21 studies also showed that epidurals do not increase the likelihood of caesarean section, but they do increase the chance of a forceps or ventouse delivery by 40% (Anim-Somuah, Cochrane Review, 2005).[39] The COMET Study, published in The Lancet in 2001 (vol358, No9275 p19-23) showed that a combined spinal epidural in labor may speed up the labor process by a few minutes, although those women receiving an epidural had a caesarean rate of 28% and only 35% had a normal birth without instrument assisted delivery.[40]
These differing outcomes may be explained by data that demonstrates that the likelihood of increased intervention is directly related to the quality of the institution or practitioner providing the care: epidurals administered at top-rated institutions do not generally result in a clinically significant increase in caesarean rates, whereas the risk of caesarean delivery at poorly ranked facilities seems to increase with the use of epidural[41]
An alternative explanation is that women are more likely to request an epidural during a prolonged or difficult labor, which in turn is more likely lead to an assisted vaginal birth.







Tiffany Patterson
www.sacredbirthsdoula.com Ft. Myers, Cape Coral, Estero, Bonita Springs, & Naples, Floirda