Contraindications of epidural anesthesia in childbirth

Epidural anesthesia is a relatively safe technique, and used by most women in their deliveries, however there are some situations that contraindicate the puncture and administration of this type of analgesia. Before putting the epidural, the anesthetist will assess certain parameters that must be ob

Epidural anesthesia is a relatively safe technique, and used by most women in their deliveries, however there are some situations that contraindicate the puncture and administration of this type of analgesia.

Before putting the epidural, the anesthetist will assess certain parameters that must be obtained from the patient to assess whether regional anesthesia can be administered or not, there are also some diseases that will cause failed anesthesia or serious complications.

7 reasons why the epidural is contraindicated

1 - Infection at the puncture site, since it can spread into the epidural space and cause cellulitis or an abscess; and in the case of dura puncture, meningitis may even develop.

Psoriasis, herpes and axillary hydroadenitis are also considered contraindications. Also the generalized sepsis (infection) is another absolute contraindication.

2 - AIDS is considered a relative contraindication, and the situation of each woman will have to be assessed.

3 - Neurological condition: these are cases to be studied in detail, since in many cases epidural anesthesia will not be administered if you suffer from some of the following neurological diseases: demyelination, peripheral neuropathy, cerebral vascular accident ....

4- Coagulopathy: the practice of any type of regional anesthesia presumes the intact state of the coagulation mechanisms.

If a woman has a diagnosis of coagulation abnormalities, or if heparin is administered during pregnancy, they are also considered relative contraindications for the use of epidurals.

5- Uncontrolled bleeding: since the epidural can cause low blood pressure due to dilatation of the blood vessels, in women with a frank hemorrhage it can be aggravated with the administration of drugs. However, medications can be used to control tension (vasoactive) and put fluids to maintain blood volume.

6- Certain cardiopathies: some cardiac alterations called "low expenditure" as well as heart block are two pathologies of the heart that contraindicate the epidural. We also fear pericarditis.

7- Rejection of technique: subarachnoid or epidural analgesia should not be attempted in patients who do not want it, however, it is always desirable and convenient for the patient to know the benefits and risks of these regional anesthesia techniques, by means of an explanation detailed, friendly and patient on the part of the anesthesiologist.