What are possible complications of cervical epidural blocks (CEBs) for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Complications can include infections; hematogenous spread is facilitated by the Batson plexus. CEBs should not be performed with any suspicion of local or widespread infection. Anticoagulation and coagulopathy are absolute contraindications, and any medication that inhibits platelet adherence or normal coagulation is a contraindication unless these medications are withheld for a reasonable amount of time that is considered safe. The time that is necessary for safety is a property that is individual and specific to the drug in question and its mechanism of action. [19, 20, 21]

Dural puncture is uncommon but, if unrecognized, may cause immediate total spinal anesthesia associated with loss of consciousness, hypotension, and apnea. Epidural doses of opioids accidentally placed into the subarachnoid space can cause profound respiratory and CNS depression. Physician recognition of these complications must be immediate to be effective. Subdural placement of epidural doses of local anesthetics can produce a clinical scenario similar to a massive subarachnoid injection. [19, 20, 21]

Needle trauma to epidural veins may also result in self-limited bleeding; in the best-case scenario, this only leads to postprocedure pain. However, uncontrolled bleeding into the epidural space can result in a hematoma with compression of the spinal cord, resulting in neurologic deficit, including cervical myelopathy. Needle trauma to the spinal cord or nerve roots is usually accompanied by pain.

Principal tenets are common sense. If the clinician encounters significant pain or opposition by the patient, the procedure should be stopped. The procedure should be stopped or completely aborted when a complication is suspected, even when it is not clearly apparent. Avoiding patients who are immunocompromised or otherwise at risk for complications should always be considered to avoid potential adverse events. [19, 20, 21]

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