Epidurals and nerve damage
Side effects and adverse reactions are rare. A dural puncture, or wet tap, is perhaps the most common complication from an ESI. This complication only occurs in 0.1 to 5 percent of all injections. The result of a dural puncture is usually a spinal headache and nausea. A spinal headache occurs when the puncture in the spinal sac fails to seal itself off. This allows the spinal fluid to continue to leak out and lowers the spinal fluid pressure in the brain. When sitting, the headache and nausea are much worse, because the spinal fluid pressure is lower at the top, near your head, than at the bottom of the spine. The headache usually goes away when you lie down with your feet higher than your head. To treat a spinal headache, a "blood patch" is usually recommended. If the doctor realizes immediately during the procedure he has a wet tap, he may perform a blood patch before he removes the epidural needle. A blood patch is a simple procedure where about three ounces of blood are drawn from an arm vein. The blood is then immediately injected into the epidural space with an epidural needle. The blood then clots around the spinal sac and stops the leak by forming a "patch". Intravascular Injection There is a small chance that the medication may be injected into one of the small blood vessels that run through the epidural space instead of the epidural space itself. This can cause seizures, cardiac arrest, and even death if too much of the medication goes directly into the blood steam. The chance of this happening is very low. Your doctor can discuss it with you in further detail. Infection Epidural injections are done under sterile conditions very similar to surgery. Still, anytime a needle is inserted into the body there is a small chance of infection. Since the needle in an epidural is going near the spine, an infection is much more serious if it occurs. The chance that an infection will occur is extremely small. Bleeding An epidural injection can result in a hematoma. A hematoma is simply a collection of blood due to an injury to a blood vessel. An epidural hematoma can be serious if it is big enough to cause enough pressure on the spinal nerves so that they quit working. This can cause problems with the bowels and bladder. Bladder Dysfunction Because the epidural injection actually paralyzes the nerves to the bowel and bladder for a short period, you may not have control over your bladder for one to two hours. Neurologic Complications There is always a small risk of damage to the spinal nerves. The spinal cord is a bundle of millions of nerves that connects the brain with the rest of the body. If the epidural needle directly injures the spinal nerves, this can cause neurologic problems. Epidural injections should be administered using either ultrasound or fluoroscopy for needle guidance.
Return to arthritis home page.
|
