What can be done to prevent nerve damage?
Anaesthetists are trained to be aware of nerve damage. Steps taken to prevent each kind of damage are described here.
- All anaesthetists performing epidural and spinal injections are trained in these techniques.
- Spinal injections are placed below the expected lower end of the spinal cord. This should prevent damage to the spinal cord itself.
- Spinal injections are usually performed while you are awake or lightly sedated. If there is pain or tingling due to contact with a nerve, you will be able to warn the anaesthetist who will then be able to adjust.
Haematoma blood clot
- If you take a medicine (an anticoagulant) to thin your blood, such as warfarin, you will be asked to stop it several days before surgery if your doctors think it is safe to do so.
- If you take clopidogrel (another medicine which thins the blood by its effect on platelets), you will usually be asked to stop it several days before planned surgery. For urgent surgery, your doctors will think about whether it is safer for you to have or to avoid a spinal or epidural injection.
- If you take aspirin, you can have an epidural or spinal injection.
All epidural and spinal injections are performed under 'aseptic conditions' (this means using special precautions to make the procedure as clean as is possible), similar to those used during the operation. Your back should be kept clean and regularly checked over the following few days.
If you have an epidural or spinal injection, the nurses will make regular checks until everything returns to normal. This should help spot any possible nerve damage very early so that treatment can be started immediately if needed.
Further reading and references
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 Feb102(2):179-90. doi: 10.1093/bja/aen360. Epub 2009 Jan 12.
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