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Neurological Complication of Epidural Anaesthesia

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Dr. Muir of Dalhousie University in Canada, mentions the following in her review([i]): "neurologic problems ranging from headache to paralysis" and she includes adhesive arachnoiditis in her list.


  • Post dural puncture headache (commonest)
  • Total spinal anaesthesia
  • Meningitis (infective or chemical)
  • Extradural haematoma
  • Extradural abscess
  • Anterior spinal artery syndrome (paraplegia)
  • Intravascular injection
  • Cauda equina syndrome(CES)
  • Transient radicular irritation(TRI)
  • Cranial nerve lesions/Horner's syndrome (v. rare)  

Hampl et al([iii]) suggested that transient neurologic symptoms are "common after spinal anesthesia" and may occur in up to "one third of the patients receiving 5% lidocaine."

Dahlgren ([iv]) wrote about Transient Radicular Irritation(TRI) having an incidence of 15-37% in those patients receiving lidocaine, procaine and mepivicaine (but not bupivicaine). He ascribes the symptoms to hemolyzed blood in the subarachnoid space.

[i] Muir HA Department of Anaesthesia, Dalhousie University, Nova Scotia, Canada, " Epidural Misadventures; A review of the risk and complications."

[ii]  With reference to: University of Queensland  Internet site "Neurological Complications of epidurals"

[iii] Hampl KF, Schneider MC, Pargger H, Gut J, Drewe J, Drasner K Anesth Analg 1996 Nov;83(5):1051-4 A similar incidence of transient neurologic symptoms after spinal anesthesia with 2% and 5% lidocaine.

[iv] Dahlgren N, Acta Anaesthesiol Scand 1998 42(4):389-390 Lidocaine toxicity: a technical knock-out below the waist?