Digital Library - Spinal Anesthesia

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Complications

  1. Dural Puncture Headache: The incidence of post-dural puncture headache is related to the patientıs age and sex as well as the size and shape of the spinal needle. Young females, especially parturients, have a higher incidence on post-dural puncture headache than older patients. Large, shape tip needles (Quincke needle) cause more headaches that small, blunt tip (Sprotte) needles. For example, the incidence of post-dural puncture headache in older men using 22 gauge needle is < 1%. In obstetric patients using a 25 gauge needle, the incidence of headache is 2-10%, whereas, with accidental dural puncture with an 18 gauge needle (epidural needle) in OB patients, the incidence is 40-70%.
    Treatment of Dural Puncture Headache: Conservative treatment for mild headache includes oral ibuprofen, oral caffeine, oral or IV fluids. An abdominal binder helps to some patients, prophylactic blood patch can be done in patients with unintended dural puncture with epidural needle. Therapeutic treatment for severe headache is epidural blood patch with 10-20 ml of autologous blood.

  2. High or Total Spinal: Most frequently it occurs during epidural anesthesia when epidural sized dose of local anesthesia is injected to subarachnoid space. Very high spinal anesthesia can occur during spinal anesthesia even though it is not very common. It is due to excessive cephalad spread of local anesthetic. It needs immediate aggressive treatment supporting respiratory and cardiovascular system.

  3. Paralysis is a rare complication, but it can occur if dural puncture is performed high causing spinal cord injury.

  4. Meningitis, although rare may result from contamination of subarachnoid space in patient who are septic, from contaminated equipment or if spinal is done when there is local infection at the site of puncture.

  5. Adhesive arachnoiditis and cauda-equina syndrome. It is rare complication from introduction of an intrathecal irritant into the subarchnoid space causing ischemia to the spinal cord.

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