Statistics show that about 70% of women in the U.S. elect to have epidural analgesia during labor. While epidural analgesia is very effective at helping women cope with the pain of labor, it is important to have an appreciation for the possible complications associated with such medical treatment. If you are an expectant mother, the last thing you want to do is think about the possible risks of epidural analgesia – while you are in labor. The decision to have epidural analgesia during labor should not be a hasty, last minute decision. The following is a survey of a number of complications associated with epidural analgesia. It is intended to provide expectant mothers with a general understanding of the various complications associated with epidural analgesia and to encourage further inquiry.
It is important to know that epidural analgesia may cause infection (i.e., epidural abscess). An epidural abscess is a collection of pus in the epidural space. As the abscess gets larger, it will eventually compress the spinal cord resulting in neurological deficits (e.g., numbness and/or weakness in the legs). An epidural abscess requires immediate medical intervention.
Moreover, be aware that certain patients with blot clotting disorders are at a higher risk for bleeding (i.e., epidural hematoma). Women who are on blood thinners (e.g., Lovenox) or who are otherwise hypocoagulable are at an increased risk for developing hematomas during epidural infusions. Epidural hematomas may also cause spinal cord compression leading to potential paralysis.
Because the epidural space is only a few millimeters wide, there is a risk that the needle used to gain access to the epidural space may cross into the subdural and/or subarachnoid space. The administration of epidural anesthesia beyond the epidural space may lead to a number of very serious complications. When epidural anesthetic agents are administered beyond the epidural space, a patient may experience low blood pressure, difficulty breathing, loss of motor function and sensation, nausea, loss of consciousness and even cardiac arrest. The puncture of the dura may lead to an outflow of cerebral spinal fluid into the epidural space. When this happens, patients complain of severe headaches, which could take days or weeks to resolve.
The inadvertent administration of an excessive amount of epidural agents may cause nerve damage as well. Anesthesiologists are very careful to select the right epidural drugs based on the patient’s medical history, comorbidities, age, height, and weight. The key to avoiding epidural toxicity is making sure that the proper dosage of an epidural medication is administered. In part, this involves a determination of the acceptable dosage per unit of body weight (i.e., ml/kg). Epidural toxicity may lead to permanent loss of motor function and sensation in the lower extremities. If you elect to have epidural analgesia, demand to be evaluated and monitored by an anesthesiologist or certified registered nurse anesthetist (CRNA) during the epidural infusion and throughout the anesthesia recovery period.
Some patients may be allergic to certain epidural agents. Because most epidural administrations involve a cocktail of different medications (e.g., fentanyl and bupivacaine), an anesthesiologist should be familiar with the patient’s history of allergies. If you are considering epidural analgesia, make sure that you are not allergic to “caine” drugs or opiates.
Epidural analgesia may also make it more difficult to push during labor. Consequently, the use of epidural analgesia may lead to other medical interventions, including the use of Pitocin and a Caesarean section.
If you are an expectant mother, talk to your obstetrician about the risks associated with epidural analgesia. The decision to proceed with epidural analgesia should be a considered decision. Your physician can avoid some, if not most, complications associated with epidural analgesia by performing a proper and thorough assessment of your risk factors and by carefully monitoring you during labor and the recovery period.
Have you or someone you know had any complication associated with an epidural? Share your story with our readers. We welcome your comments.