neuraxial complications

complications epidural anaesthesia neuraxial spinal anaesthetic Oct 20, 2025

Not quite right: Neuraxial complications explained 🌿

Neuraxial anaesthesia, encompassing both spinal and epidural techniques, is highly effective, but like all medical procedures, they carry specific risks that perioperative nurses must recognise and continue to monitor for. The pattern and likelihood of complications vary between epidural and spinal anaesthesia, due to differences such as anatomy, technique, and drug spread.

🔹 Spinal Anaesthesia 🏥
Spinal anaesthesia involves injection into the cerebrospinal fluid, involving a deliberate dural puncture in order to reach the correct space. Therefore, complications can include:

  • Post dural puncture headache (PDPH) (occurs in approx 0.3–1% spinals)
  • Hypotension and bradycardia are common due to sympathetic blockade
  • High or total spinal block – if excessive spread compromises respiratory function
  • Transient neurological symptoms (motor or sensory)
  • Urinary retention
  • Infection or haematoma (rare)

🔹 Epidural Anaesthesia ❤️
Epidural anaesthesia carries a different profile, and generally a longer monitoring window due to the catheter remaining in situ:

  • Catheter migration or dislodgement
  • Unilateral/patchy block
  • Local anaesthetic toxicity – if catheter is unintentionally placed into a blood vessel
  • Unintended high spinal if catheter is placed in the subarachnoid space
  • Accidental dural puncture (1 in 100–200 insertions – 80% chance of developing PDPH)
  • Infection, epidural abscess or haematoma
  • Transient neurological symptoms or nerve damage (rare)

Both techniques demand close observation and communication between nurses and anaesthetists. Early detection of adverse changes is vital to prevent escalation or worsening of symptoms and optimise patient outcomes and care.

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References:

Australian and New Zealand College of Anaesthetists. (2014). PG03(A) Guideline for the management of major regional analgesia. https://www.anzca.edu.au/getContentAsset/a70212ec-6074-4fa5-a62b-742f1f64523a/80feb437-d24d-46b8-a858-4a2a28b9b970/PG03%28A%29-Guideline-for-the-management-of-major-regional-analgesia-2014.PDF?language=en&view=1

Australian Society of Anaesthetists. (n.d.). Epidural and spinal anaesthesia and analgesia. https://asa.org.au/epidural-and-spinal-anaesthesia-and-analgesia

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