How does nerve damage happen?
There are different ways that nerve damage can be caused by a spinal or epidural injection.
The epidural or spinal needle or the epidural catheter may, rarely, damage a single nerve, a group of nerves or the spinal cord. Contact with a nerve may cause 'pins and needles' or a shooting pain. This doesn't mean that the nerve is damaged; however, damage may occur if the needle is not immediately moved to another position.
If you do suddenly feel an area of pain, numbness or pins and needles, try to stay still and tell the anaesthetist about it. The anaesthetist will change the position of the needle and the sensations will usually improve immediately.
Most cases of direct damage are to a single nerve and are temporary. Injecting medication into the nerve rather than into the area surrounding it can cause more severe damage to the nerve.
A collection of blood (a haematoma) may collect near to the nerve, due to damage to a blood vessel, caused by the needle or the catheter. A large haematoma may press on a nerve or on the spinal cord and so cause damage. This is a very rare problem but you may need an urgent operation to remove the haematoma and relieve the pressure.
If your blood does not clot normally or you take a blood-thinning medicine such as warfarin, you are more likely to get a haematoma. You will usually be asked to stop these medicines before you have an epidural or spinal injection. If the epidural or spinal injection is needed more urgently then you may not be able to have the spinal or epidural injection - in which case you will be advised on an alternative.
Most infections related to a spinal injection or an epidural are local skin infections and do not cause nerve damage. Very rarely, an infection can develop close to the spinal cord and major nerves. There may be a serious infection such as a collection of pus (an abscess) or meningitis. These infections need urgent treatment with antibiotics and sometimes an operation to prevent permanent nerve damage.
You have a higher risk of a serious infection if you already have a significant infection elsewhere (such as a chest infection or skin infection), or if you have a weak immune system.
Inadequate blood supply
Low blood pressure is very common when you have an epidural or spinal injection. This can reduce the blood flow to nerves and this may, rarely, cause nerve damage. Medicines and intravenous fluid may be needed to prevent large drops in blood pressure.
What else can cause nerve damage?
If you have nerve damage, you should not assume that it is caused by the epidural or spinal injection. The surgical operation may be the cause of the nerve damage.
If you have a medical condition that interferes with blood supply (for example, diabetes) or nerve function (for example, multiple sclerosis), this can make damage more likely or make it more difficult to know exactly what has caused the nerve damage.
Did you find this information useful?
- Nerve damage associated with a spinal or epidural injection; Royal College of Anaesthetists, Last updated February 2017
- Cook TM, Counsell D, Wildsmith JA; Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth. 2009 Feb 102(2):179-90. doi: 10.1093/bja/aen360. Epub 2009 Jan 12.
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