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Epidural side effects and complications

In skilled hands, epidural analgesia and combined spinal-epidural (CSE) are very safe for both mother and baby, but there is a small risk of complications, even when the best technique is followed. The important complications are outlined below.

Low blood pressure: This is a common complication. Every patient who has an epidural receives intravenous fluids to prevent a fall of blood pressure. Blood pressure is carefully monitored before, during and after starting an epidural, so that low blood pressure may quickly be treated with either drugs or extra fluid.

Shivering: This is not a serious side effect but occurs quite commonly in the first hour after having an epidural. It is usually associated with prolonged or advanced labour. An extra blanket may help this symptom.

Bladder control: You may be unaware of a full bladder. A catheter may be needed to empty the bladder during labour.

Inadequate pain relief: Sometimes there is inadequate pain relief in spite of the epidural. If this happens, the epidural catheter may have to be adjusted or the procedure may need to be repeated.

Back pain: Back pain after delivery is often said to be caused by the epidural but is most often related to the labour and delivery process. Also, pregnancy itself can cause back pain. However, a difficult epidural insertion may cause bruising between the bones of the spine, resulting in low back pain after the epidural has worn off. Usually this pain lasts just a few days.

Headache: Epidural analgesia may lead to a headache if the needle goes deeper than the epidural space. The headache is severe, and without treatment it may last more than a week. Fortunately, there is an effective method of treatment available. The risk of this headache is approximately 1 in 200.

Persistent numbness or weakness: Nerve damage may cause prolonged numbness or partial weakness in one leg, which can last several weeks. It occurs 1 in 2,500 births and is usually caused by pressure from the baby on nerves that pass through the pelvis. This type of nerve injury can rarely be caused by pressure from the epidural catheter on the nerve in the back. If your legs do not return completely to normal after an epidural, make sure to inform your post-partum nurse so that you will be seen by your anesthesiologist before you go home.

Severe injury: Severe, permanent nerve damage or life threatening complications are rare. Severe drug reactions, such as convulsions, may occur in 1 in 10,000 administrations. Severe brain damage, coma, paralysis and death are even less common: about one case in 100,000. To put these figures in perspective, the risk of severe injury or death due to an epidural is about the same as the risk of death occurring due to crossing the road or riding in a car.

For more information about epidural analgesia for labour, please see the Division of Obstetrical Anesthesia.