Published: Вт, Января 31, 2017
World | By Tasha Manning

Epidural Nerve Block: Overview, Indications, Contraindications

Epidural and spinal anesthesia are used extensively, consistently, and securely in modern practice. Although the technique appears relatively straightforward in experienced hands, it is not free of potential complications. The severity complications of regional anesthesia are far less commonly disclosed. According to a 2003 survey of 79 regional anesthesiologists and regional anesthesia fellows, the complication rates provided to patients may not match those cited in the literature.The risks of regional anesthesia that are most commonly reported to patients by academic regional anesthesiologists occur frequently and are benign In nature.

Severe complications (eg, spinal epidural hematoma) leading to temporary or permanent disability have been attributed to central neuraxial blocks.Infections like meningitis and abscesses, or cerebral ischemia or hemorrhage have also been linked directly or Indirectly to spinal or epidural anesthesia.On rare occasion, central nerve blocks have caused permanent damage to the spinal cord or nerve roots.The etiology of this damage in many cases remains unclear.

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Perhaps the clearest picture of the Numbers and types of injuries from regional anesthesia are provided by the American Society of Anesthesiologists (ASA) Closed Claims Project database. The report clearly noted twice the complications with general anesthesia than with regional anesthesia. The primary reason for death remains cardiac arrest associated with neuraxial blockade.This complication now represents only 30% of deaths (vs. 61% in the 1970s and 40% in the 1980s).

A report reviewed 32 studies published between January 1, 1995, and December 31, 2005. The main objective was to investigate neurological complications of regional anesthesia. An epidural block interrupts both somatic and sympathetic nerve. An epidural block interrupts both somatic and sympathetic nerve. Conduction; Thus, cardiovascular changes, including hypotension and tachycardia, may occur. These cardiovascular changes can produce overwhelming complications if not promptly identified and treated. Respiratory compromise or failure to occur if the phrenic nerve or respiratory centers of the brain are inadvertently blocked. For this reason, epidural nerve blocks should be performed only by clinicians trained in airway management and resuscitation. Minor adverse effects and complications of epidural nerve block include pain at the injection site, unintentional dural puncture, and vasovagal syncope. Major complications include damage to neural structures, epidural hematoma, and epidural abscess. These major complications are rare but can be life-threatening when they occur. Coexisting Harlequin and Horner syndromes after high thoracic paravertebral block have also been reported.

With the exception of the decreased incidence of inadvertent dural puncture, the complications of the caudal approach to the epidural space mirror those of the lumbar approach . Because of the proximity of the rectum, conscientious attention to sterile technique should be observed to avoid infection, which can easily spread to the epidural space via the Batson plexus. Because of the vascular nature of the epidural space, the potential for local anesthetic toxicity remains ever present.

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