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Complication Risk

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Common

• Hypotension +/- bradycardia (sympathetic block)
• Fetal bradycardia
• Headache (post dural puncture)
• Ineffective block
• Pruritis
• Nausea
• Urinary retention </aside>

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Rare but serious

• Intravascular injection (local anesthetic toxicity)
• High Spinal/ total spinal anesthesia
• Spinal/Epidural hematoma
• Infection (spinal/epidural abscess, meningitis, cellulitis)
• Arachnoiditis
• Nerve root injury
• Spinal cord injury
• Delayed respiratory depression
• Anaphylaxis </aside>

Contra-indications

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Over-laying Cellulitis.

Use of Anti-Coagulant.

Fixed CO.

Pre-existing neurological deficits (relative). Respiratory Disease (relative).

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• Patient refusal
• Severe hypotension/hemodynamic instability
• Infection at the site of epidural puncture
• Pre-existing sepsis or bacteremia
• Severe coagulopathy or full anticoagulation
• Cardiovascular (fixed cardiac output lesions)
• Neurologic (raised intracranial pressure, pre-existing neurologic disease)
• Musculoskeletal (severe scoliosis or back surgery may lead to technical failure of block)
• Obstetrical (patient not in labour)