Epidural Blockade: Safe Practice and Management of Adverse Events

Abstract

Epidural anesthesia and analgesia has been the mainstay for pain control following many surgical procedures. Despite a gradual decrease in popularity, it remains a relevant and important modality for certain subspecialties such as obstetrics. In this chapter, key themes in the safety and quality of epidural anesthesia, including combined spinal–epidural (CSE) techniques, are highlighted. Practice points which might help to make our epidural procedures as safe as possible are presented in this chapter and complication rates should improve by incorporating these measures. Complications may arise from block-induced physiological changes, wrong drug/adverse drug effects, or issued with needle/catheter insertion. Although rare, serious neurologic injury is a risk that must be considered, and the decision to perform an epidural should be made on a patient-by-patient basis. Certain risk factors exist that may predispose to complications with an epidural, and the anesthesiologist must be aware of these and any coincidental conditions that could mimic neurologic injury following epidural anesthesia. Intravertebral hematoma can result in spinal cord compression, which may lead to serious neurologic consequences; practice guidelines should be followed when considering an epidural for an anticoagulated patient. Intravertebral infection can lead to abscess and, in severe cases, meningitis; proper antiseptic technique should be followed to minimize the risk of introducing bacteria into the epidural space. Spinal cord ischemia, trauma to the spinal cord/nerve root, and arachnoiditis are other potential complications associated with epidural anesthesia. Care should be taken to eliminate any chance of wrong route errors or infusing the wrong drug. As with all anesthetic procedures, the safety of epidural blockade reflects the psychomotor skills and judgment of the operator, as well as the possibility of human or system error.