• Some complications have been discussed already under the heading “Is an epidural safe?”
• Blood pressure drop. Because the local anaesthetic also blocks the nerves that innervated blood vessels, these blood vessels will relax and dilate, with a drop in blood pressure as a result. This drop is mostly mild, but can be more pronounced if the patient is dehydrated or taking medication against high blood pressure. Before performing an epidural, the anaesthetist will therefore make sure to give some extra fluids intravenously. It is also advisable not to take certain of your medication against high blood pressure while the epidural infusion is running.

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  Itch and nausea. Sometimes the anaesthetist adds morphine or related drugs to the epidural mixture that is infused postoperatively. A cumbersome side-effect, especially of the morphine, is nausea and itch, but is fortunately easy to treat.
• Sedation and respiratory depression. Again morphine and related drugs are responsible for this, but especially morphine. They can make you feel a bit drowsy and sleepy, and decrease your impulse to breathe. Fortunately this rarely happens, but the nursing staff will have to check every two to four hours if the patient on an epidural is not becoming too sleepy and still breathing fine.
• Headache. Another complication, which is also rare, not dangerous, but uncomfortable, is headache. The incidence is about seven in 1 000 epidurals. It is due to the epidural needle accidentally making a small hole in the dural membrane, so that spinal fluid leaks out. This spinal fluid is in direct connection with the fluid around the brain, and any disturbance in the volume of this fluid puts stress on the sensitive ligaments around the brain, hence the headache. It is mostly self-limiting, but sometimes takes weeks to resolve.
  The intensity of this headache ranges from mild, and easily treated, to severe, where the patient has to lie flat for a few days, sometimes up to a week or more. In severe cases, the only helpful treatment is to seal the hole in the dural membrane through which the spinal fluids leaks out. This is done with a so-called blood patch: into the epidural space is a small amount of the patient’s own blood injected, which will in 70% of cases give immediate relief.
  A less invasive treatment is acupuncture. It involves two small acupuncture needles in the top part of the neck muscles, and often gives good relief. If necessary, it can easily be repeated without any danger.

Read more:
Natural approach to headaches
Cluster headache

Links:
Arthritis Foundation of South Africa
Multiple Sclerosis South Africa
The South African Society of Physiotherapy

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