Contraindications
There are circumstances where the risks of an epidural injection are higher than usual. These circumstances include:
- Anatomical abnormalities, such as spina bifida or scoliosis
- Previous spinal surgery (where scar tissue may hamper the spread of medication, or may cause an acquired tethered spinal cord)
- Certain problems of the central nervous system, including multiple sclerosis or syringomyelia
- Certain heart-valve problems (such as aortic stenosis, where the vasodilation induced by the anaesthetic may impair blood supply to the thickened heart muscle.)
- Bleeding disorder (coagulopathy) or anticoagulant medication (e.g. warfarin) - risk of spinal cord-compressing hematoma
- Infection near the point of intended insertion
- Infection in the bloodstream which may "seed" via the catheter into the (otherwise relatively impervious) central nervous system
- Uncorrected hypovolemia (low circulating blood volume)
- Allergy to the anaesthetic
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