From the Guidelines
The most common complication of epidural analgesia is hypotension, as it can affect up to 30% of patients receiving epidural analgesia, according to the most recent evidence from 1. This occurs when the local anesthetic used in the epidural blocks sympathetic nerve fibers, causing vasodilation and decreased peripheral vascular resistance. The resulting drop in blood pressure typically happens within 20-30 minutes after administration.
Management and Prevention Strategies
Management includes:
- Intravenous fluid administration (typically crystalloids like normal saline)
- Positioning the patient on their side or with left uterine displacement if pregnant
- Sometimes vasopressors such as ephedrine (5-10 mg IV) or phenylephrine (50-100 mcg IV) if the hypotension is severe or symptomatic Prevention strategies include:
- Pre-hydration with 500-1000 mL of IV fluids before epidural placement
- Careful titration of local anesthetic doses
Other Complications
Other common but less frequent complications include:
- Post-dural puncture headache
- Inadequate analgesia
- Urinary retention
- Pruritus (especially with opioid additives)
- Motor blockade affecting mobility
These complications are supported by various studies, including 1, 1, 1, and 1, which highlight the importance of careful management and monitoring of patients receiving epidural analgesia. However, the most recent and highest quality study, 1, prioritizes hypotension as the most common complication, guiding the recommendation for its management and prevention.
From the Research
Most Common Complication of Epidural Analgesia
The most common complication of epidural analgesia is:
Evidence from Studies
- A study published in Anesthesia and analgesia in 2003 found that ephedrine and phenylephrine are used to treat hypotension during combined general and epidural anesthesia 2
- Another study published in Anesthesiology in 2004 found that the most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia 3
- A systematic review published in American journal of obstetrics and gynecology in 2002 found that hypotension during labor is common, but usually mild and necessitates treatment infrequently 4
Comparison with Other Complications
- While respiratory depression is a potential complication of epidural analgesia, the available evidence suggests that hypotension is more common 3, 4
- Other complications such as infection, hematoma, and nerve trauma are rare, but can occur 5, 6
Incidence of Complications
- A nationwide study published in Acta anaesthesiologica Scandinavica in 2016 found that the incidence of spinal hematoma and epidural abscess associated with epidural analgesia is very low, especially in obstetric patients 6