What are the complications of epidural puncture needle injection?

1. There are two common reasons for catheter breakage. One is improper operation. It is more common when the puncture needle has not been pulled out after the catheter is placed. When the catheter needs to be pulled out, the catheter is pulled out by mistake. Some of them were cut off by the needle bevel knife-like needle, and remained in the epidural space. Some of them were due to some reasons, such as the diseased position or the stenosis of the patient's own intervertebral space, which made it difficult to pull out the catheter. When the doctor pulled it out forcefully, it could also cause Broken catheter. The second is the poor quality of the catheter. Especially when the catheter is indwelled for a long time, it is easy to cause the catheter to break.

2. Misinjection of drugs is caused by the careless mistakes of medical staff. Reported in the literature are wrong injection of ethanol, high concentration of sodium chloride, potassium chloride and so on. Misinjection of ethanol into spondylosis that should not be performed nerve destruction will cause irreparable damage to the root nerve. Hyperkalemia caused by high-dose injection of potassium chloride can cause serious damage and dysfunction of important organs of the heart and kidneys, and even life-threatening. Patients with hyperkalemia often experience decreased muscle tone, loss of tendon reflexes, difficulty swallowing, breathing and pronunciation, bradycardia, conduction block, sinus arrest, and even cardiac arrest. Immediately after the discovery, strong measures should be taken to make the blood potassium drop rapidly in the shortest time.

3. Extensive spinal nerve block puncture needle or catheter mistakenly entered the subarachnoid space and injected a local anesthetic that exceeds the amount of spinal anesthesia several times. Patients often present with no pain, hypotension, loss of consciousness, and respiratory arrest, or even cardiac arrest, in all areas of spinal innervation. When the above symptoms occur, immediate measures should be taken to maintain respiratory and circulatory functions, some drugs to maintain blood pressure should be used in moderation, and tracheotomy should be performed to pressurize oxygen inhalation if necessary. Usually the patient wakes up in about 30 minutes. Occasionally, an abnormally extensive spinal nerve block can also occur after the use of conventional doses of local anesthetics in the epidural space, but the range of the block is segmental, and the symptoms appear slowly and mostly mild. However, attention should also be paid to vital signs, and the above-mentioned measures can be taken for first aid if necessary.

4. Epidural hematoma puncture or placement of epidural catheter to damage epidural venous plexus, excessive bleeding or coagulation dysfunction. Manifested as symptoms of spinal cord compression, angiography or CT is helpful for diagnosis.

5. Epidural abscess caused by infection during operation. In addition to local infection symptoms and signs, there are often systemic signs of infection, such as headache, chills and fever, leukocytosis, low back pain and percussion pain, and nerve root irritation symptoms. After diagnosis, incision and drainage should be made in time, and antibiotics should be applied systemically or at the same time in the epidural space to quickly control the infection.

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