Side effects and complications of regional anesthesia

Bhavani Shankar Kodali MD

The anesthesiologist takes special precautions to prevent complications.  Although side-effects are rare, they occasionally include the following. Some of the side effects may be specific to the circumstances of your presentation. Therefore you should discuss them with your anesthesiologists.

Shivering: Shivering may occur and is a common reaction. Sometimes it happens during labor and delivery, even if you have not received any anesthetic medications. Keeping you warm often helps it subside.

Decreased blood pressure: You will receive intravenous fluids and your blood pressure will be carefully monitored and treated. Decreases in blood pressure are expeditiously corrected.

Mild itching during labor: This is a result of narcotics used in the epidural/spinal medications. If itching becomes bothersome, your anesthesiologist can treat it with medications. Most women find itching to be mild.

Local anesthetic reaction: While local anesthetic reactions are rare, they can be serious. Be sure to tell your anesthesiologist if you ever had any allergic reaction to local anesthetic medications.

Breathing problems: On rare occasions, the anesthetic medication may affect the chest muscles and make it harder to breathe. Oxygen can be given to relieve this and help the breathing.

Injection into veins: The veins located in the epidural space become swollen during pregnancy. There is a risk that the anesthetic medication could be injected into one of them. To help avoid unusual reactions stemming from this, your anesthesiologist will first administer a test dose of medication and you may be asked if you notice any dizziness, a funny taste, numbness of ears, dizziness or rapid heart beat.

Persistent pain in some areas/no pain relief: Sometimes the anesthetic does not reach an area leaving a "spot" which is still painful. Your anesthesiologist may change your position on the bed or withdraw the epidural catheter to relieve the pain. Occasionally the epidural catheter may need to be removed and reinserted again if you do not get adequate pain relief. Your anesthesiologist will work with you  to make you comfortable.

Paresthesias (feeling of nerve sensations): Transient "Feeling of nerve sensations/electric shock" (hitting your funny bone) can occur while inserting the epidural catheter as it brushes against the nerves in the epidural space. Although these sensations are common during epidural injections, permanent nerve damage is extremely rare. 

Back pain: You may have localized back pain from the needle insertion, which should last a day or so. On the other hand, you may experience generalized back pain, which is not necessarily attributable to the epidural. Studies have shown that mothers who have natural childbirth deliveries are as likely to experience generalized back pain lasting a few days as those who have epidurals. It seems that pregnancy itself can increase the incidence of back pain because of softening of the ligaments resulting in back strain.

Headache: There may be several reasons why you can get a headache after labor and delivery that are unrelated to epidural anesthesia. However, although uncommon, a headache may develop following the epidural block procedure (<1%). This occurs as a result of a needle hole in the sac containing fluid (spinal fluid) during the epidural procedure. Leakage of spinal fluid into the epidural space may result in headache. By holding as still as possible while the epidural needle is placed, you help to decrease the likelihood of a headache. Usually the headache occurs in about 24 hours following the epidural block. Typically, the headache occurs while you sit up and relieved by assuming lying down position. The head and neck discomfort sometimes lasting few days, often can be reduced or eliminated by simple measures such as lying flat, drinking fluids and taking pain tablets. Occasionally, a patient may need additional treatment if the headache persists, or associated with other features such as nausea,  difficulty in seeing light, or hearing noises.

A major complication such as nerve damage, bleeding into the epidural or spinal space, paralysis, and infection are extremely rare events

Since epidural anesthesia involves needle placement in the back, there is a natural tendency to assume that any post-delivery nerve problem is due to the epidural anesthesia.  However, the majority of nerve problems following labor and delivery are commonly due to the impinging of the nerves by the moving baby along the birth canal, and rarely to regional anesthesia.  If you experience any weakness in the legs or other nerve problems, your anesthesiologist will help to evaluate the problem and make sure you have the proper follow-up.  

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