Spinal or Epidural Hematoma
Trauma during neuraxial techniques to epidural veins is usually benign and self limiting. A clinically significant spinal hematoma can occur following spinal or epidural anesthesia, particularly in the presence of abnormal coagulation or bleeding disorder.
The following factors increase the risk for developing a spinal or epidural hematoma:
- Anticoagulant use or disease processes that affect coagulation
- Multiple attempts during neuraxial blockade
- Formation of a hematoma after epidural catheter removal
Bleeding in the subarachnoid/epidural space will result in the compression of neural tissue. Due to anatomical factors, it is not possible to apply pressure to compress blood vessels and stop the bleeding. Compression of neuraxial structures result in ischemia and subsequent injury. The onsets of symptoms are generally rapid and include the following:
- Sharp back and leg pain
- Progression of numbness and motor weakness
- Sphincter dysfunction
Urgent referral and surgical decompression must occur within 8-12 hours of onset to avoid permanent injury.
Meningitis and Epidural Abscess
Inadequate sterile precaution causes meningitis and epidural abscess which lead to permanent neurological damage.
Cauda Equina Syndrome
Cauda equina syndrome (CES) was associated with the use of 5% lidocaine. CES is characterized by bowel and bladder dysfunction together with paresis of the legs. Sensory deficits may be patchy, typically occurring in a peripheral nerve pattern