From the Guidelines
Dizziness after an epidural is most commonly caused by hypotension, which is a temporary drop in blood pressure due to the epidural medication affecting the nerves that regulate blood vessel tone. This condition typically resolves within a few hours to days. If you're experiencing dizziness after an epidural, it is essential to stay hydrated and avoid sudden position changes, especially when moving from lying to sitting or standing. When getting up, do so slowly by first sitting at the edge of the bed for a minute before standing.
Causes and Management
The dizziness can also be a symptom of a post-dural puncture headache if the epidural needle accidentally punctured the dural membrane. According to 1, the incidence of dizziness after a lumbar puncture, which is a similar procedure, is reported to be around 1.3%. If your dizziness is severe, persistent beyond 24-48 hours, or accompanied by a severe headache that worsens when sitting or standing, it is crucial to contact your healthcare provider immediately.
Treatment Options
Treatment may include bed rest, increased fluid intake, caffeine, or in severe cases, a blood patch procedure where a small amount of your blood is injected into the epidural space to seal any leak. Pain medications like acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil) 400mg every 6 hours may help with associated headaches, but it is always best to consult your doctor before taking any medication after a medical procedure.
Recent Guidelines
Recent guidelines from 1 suggest that for post-dural puncture headache, which could be a cause of dizziness, certain procedural interventions may be used, but the efficacy and safety of these interventions can vary. For instance, greater occipital nerve blocks may be offered to patients with post-dural puncture headache after spinal anesthesia with a narrower-gauge needle, although headache may recur in a substantial proportion of patients.
Key Recommendations
- Stay hydrated to help manage dizziness.
- Avoid sudden position changes to reduce the risk of worsening dizziness.
- Consult your healthcare provider if dizziness is severe, persistent, or accompanied by a severe headache.
- Follow the recommended treatment plan for any associated headaches or post-dural puncture headache, which may include rest, fluids, caffeine, or in severe cases, a blood patch procedure.
From the Research
Causes of Dizziness after Receiving an Epidural
- Dizziness after receiving an epidural can be caused by various factors, including hypotension, which is a common complication of epidural anesthesia 2, 3, 4.
- Hypotension can occur due to the sympathetic blockade caused by the epidural, leading to vasodilation and a decrease in blood pressure 3, 4.
- The incidence of hypotension can be reduced by administering epidural phenylephrine in combination with alkalinized lidocaine 3.
- Dizziness can also be caused by postdural puncture headache or positional vertigo, which can occur after the placement of an epidural catheter 5.
- In some cases, dizziness can be an isolated symptom without headache, and can be treated with an epidural blood patch 5.
- Spontaneous cerebrospinal fluid leaks can also cause low-pressure headaches and dizziness, which can be treated with an epidural blood patch 6.
- The dermatome level of the block and the maximal fall in blood pressure can also contribute to the occurrence of dizziness and hypotension 4.