Anesthesiologists Say Complications from Epidurals ‘Very Rare’

Anesthesiologists Say Complications from Epidurals ‘Very Rare’

Weeks after the Food and Drug Administration warned of serious complications from epidural steroid injections,  American Society of Anesthesiologists (ASA) called the risk of complications from epidurals during childbirth a “myth” and said the procedure was “one of the most effective, safest and widely used forms of pain management for women in labor.”

The ASA also published a new study in the journal Anesthesiology, calling the risk of serious complications “very rare,” occurring in about 1 of 3,000 cases.

Doctors prepare to make anesthesiaThe complications may be rare, but for those who have them, they are devastating.

“This procedure can relieve pain for a few hours, or it can cause pain worse than labor every day for the rest of your life,” says Dawn Gonzalez, whose spine was punctured and permanently damaged by an epidural during child birth.

Gonzalez now suffers from Arachnoiditis, a chronic inflammation in the arachnoid membrane that surrounds her spinal cord. Her membrane was punctured by a needle during the epidural, triggering inflammation that caused scar tissue to adhere to the nerves in her spinal cord. Eventually her nerves become encased in scar tissue, causing severe chronic pain and disability.

“As a mother injured by an obstetric epidural myself, it took three years before two plus two was put together, and it was realized that I had adhesive Arachnoiditis from my single birth epidural. It’s all about informed consent. Honest, true informed consent,” said Gonzalez, who wrote about her experience in a column on National Pain Report published alongside this article.

Epidurals during child birth or to control back pain are two of the most common medical procedures performed today. About 9 million epidural steroid injections, mostly for back pain, are performed annually in the U.S. And more than 60 percent of American women in labor get an epidural, spinal or combined spinal-epidural anesthesia to control their pain during childbirth, according to the National Center for Health Statistics.

But only recently has the risk of serious complications related to obstetric anesthesia been analyzed in a large scale study.

Researchers for the Society for Obstetric Anesthesia and Perinatology gathered data from over 257,000 deliveries in which epidural, spinal or general anesthesia was administered during childbirth. Thirty healthcare facilities participated in the Serious Complication Repository (SCORE) Project between 2004 and 2009.

They found a total of 157 serious complications, 85 of which were anesthesia-related. The two most frequent complications were an excessive dose of anesthesia (one in 4,336 deliveries) and respiratory arrest during labor and delivery (one in 10,042).

An “unrecognized spinal catheter” – the accidental puncture of a spinal membrane – occurred in about one in 15,435 deliveries.

“This is the first multicenter study to examine the incidence of serious complications associated with obstetric anesthesia,” said lead author Robert D’Angelo, MD, a professor of anesthesiology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

“We were extremely pleased to find that serious complications such as bleeding, infection, paralysis and maternal death were extremely rare. However, since many complications can lead to catastrophic outcomes, it is important that physician anesthesiologists remain vigilant and prepared to rapidly diagnose and treat any complication, should it arise.”

The numbers may be reassuring to anesthesiologists, but many expectant mothers remain leery about epidurals. In a study published last year in the International Journal of Obstetric Anethesia, over a third of the women (39%) surveyed expressed concern about epidurals, with many saying they were worried about complications and preferred a natural childbirth.

“My own mother didn’t want me to have an epidural because she thought it would hurt my baby,” said lead author Paloma Toledo, MD, an obstetric physician anesthesiologist and assistant professor of anesthesiology at Northwestern University Feinberg School of Medicine, Chicago.

“But when I showed her the overwhelming scientific evidence that it was safe for me and the baby, she felt good about my decision.”

Dawn Gonzalez is not convinced and says researchers need to follow mothers for years after their epidurals to determine the long term risks from the procedure.

“The complications a lot of the times do not show immediately,” Gonzalez wrote in an email to National Pain Report.

“These injections are done completely blindly, so the chance of missing is quite high. I had a slight, unnoticeable scoliosis myself, and that is how I was damaged so badly. Other things come into play, like being overweight, or any of the bony landmarks that they use being different on your body. It’s basically playing roulette!”

Authored by: Pat Anson, Editor

There are 7 comments for this article
  1. Jeff at 7:06 pm

    In refute to what “Bonnie” stated, ESIs or epidural steroid injections are sometimes but NOT commonly done by nurse anesthetists (although that would not necessarily be a negative per se) but ARE usually done by pain management specialists with fluoroscopic guidance such as neuro- spine surgeons, anesthesiologists, ortho- spine etc. The credentials one holds (i.e. their specialty field) does NOT indicate the skill level of the practitioner. Just wanted to clarify. I am a nurse anesthetist and I have placed over 2000 labor epidurals without a serious complication. The best pain doc I have ever seen WAS anesthesiologist. Don’t paint with a broad brush.

  2. Bonnie at 12:08 pm

    Anesthesiologists don’t usually perform the ESI’s. It is usually Nurse Anesthesists or sometimes even lesser trained radiologists. They don’t tell the expectant mother or the family that neurotoxic agents are those containing ethylene glycols (Depo-Medrol® , Depo-Medrone®, Aristocort® and Methylprednisolone Suspension® which is in Anti Freeze. When introduced into the subarachnoid space these materials can be highly neurotoxic and disabling which causes Adhesive Arachnoiditis. Since none of these steroids is approved, by their manufacturers, for epidural injection, and they are clearly known to be TOXIC if misinjected. They are still used by a majority of physicians and medical personnel performing epidural steroid injections.

  3. Denise Molohon at 3:54 am

    Much more needs to be done by independent scientific review over a much longer period of time to get to the truth and the facts behind the harm of these injections whether they be for childbirth or for pain. Relying on research done by the very people who earn their living giving “anesthesia” is more than a little biased. To quote a highly credible source, Dr. William Landau, the Chief Professor of Neurology at Washington University School of Medicine, “Perhaps it is time to re-think our entire pain management philosophy. After all, the foundation of steroid injections for pain is perilously close to voodoo medicine. In short, epidural steroid injections are nothing more than medical malpractice on a national scale.” That was in reference to the many injections given for low back pain which are given in the millions each year.

    In reference to childbirth, as Dawn Gonzalez pointed out in the article above, these doctors, many of them NOT anesthesiologists, are giving these injections “blind” without the aid of any guidance like fluoroscopy into the spine and do MISS the target and do injure the mothers. Arachnoiditis symptoms many times develop over time. Simply taking a sampling survey immediately following childbirth can’t possibly find all those who have been harmed by an epidural.

    This article brings to light what many in the medical community would like never to be uncovered with regard to epidural steroid injections into the spine and have been downplaying for decades…. Look beneath the water for the true size of this iceberg.

  4. Dr. Nancy, Your Birth Coach at 8:02 am

    What is not being discussed are also the effects of the epidural on labor and how that can lead to other complications and interventions (which would otherwise have been unnecessary) which then raise both the short term and long term risk to both mom and baby. Most women are not told that their baby could be sleepy as a result of the medications in the epidural and may have a harder time with the initiation of breastfeeding. They are also not told that it reduces the release of their own endorphins and oxytocin, which will affect the chemical cocktail of hormones that leads to bonding immediately after birth. They are not told that babies born on epidural anesthesia are more likely to need to be observed more closely by hospital staff, interfering with the critical first hour of bonding. Many women are not told that an epidural may not actually work and that they need to be prepared for other pain coping practices. Many are not told that if the epidural wears off they will be in more pain than a woman who reached that point of labor naturally because her own endorphins will not have kicked in. Her labor may slow or stop and lead to the use of pitcoin, which carries it’s own set of risks. Her blood pressure could plummet creating a critical situation needing more intervention. Baby could experience distress, leading to intervention or cesarean.

    Informed choice is key. Omitting or minimizing information like the possibility of respiratory failure, adhesive arachnoiditis, or even slowing of labor and increased chance of forceps delivery is denying a woman a right to informed consent. Only she can be the one to asses what risk she is willing to take for what benefit. Any woman who has not been given all the risks, short term and long term, has not legally given her consent to the procedure.

    This should all be presented prenatally so she can make a clear minded decision, not in the heat of labor. If she has had a chance during pregnancy to critically assess ALL the risks and benefits, she can be prepared with other strategies to manage the intensity of labor and will also know in which situations she would be willing to take the risks of an epidural.

    Women should also not be offered or pressured into epidurals because of the routines and convenience of hospitals. There are valid uses and should be reserved for those situations when it is necessary or a woman has requested it after makes a fully informed choice.

  5. Pharmacist Steve at 8:09 pm

    Every time a pharmacist makes a med error and some one gets hurt.. especially the chains.. will come out with comments that medication errors are VERY RARE… what they are really saying is that the number of errors that reach the media.. because we could not get them to settle for $$$ and sign a non disclosure agreement is VERY RARE !..
    I have always wondered how many case of meningitis are “dismissed” as part of the risk of having a spinal procedure.. just do a web search about the New England Compounding Center mess a couple of years ago… 70 +/- died and abt 700 still suffering from a fungal meningitis … It is rare… unless it is you that is affected.. and then it is 100% !

  6. Nicola Reeves at 2:37 pm

    I live in New Zealand. 27 years ago I was permanently disabled from an obstetric epidural. I now have adhesive arachnoiditis.
    Living with the constant chronic pain and complications from biwel bladder and other dysfunction takes every ounce of my grit to keep living.

    I was given marcaine (anaesthetic) which back in 1986 contained preservatives which were then banned in 1989. My dura was punctured during the epidural.
    I was ridiculed by the health profession for 26 years until I finally received a diagnosis. Because arachnioditis is so underreported and generally unknown by specialists. It is mostly missed and not Eben considered.
    There must be many thousands of people in the world that have arachnioditis that are as yet undiagnosed but battle with its effects on their bodies.
    It is no myth! !!

  7. Doc ForthePeople at 11:14 am

    One of the problems that occurs with gathering accurate statistics is the simple fact that the majority of people who suffer worsened pain after epidural steroid injections receive little or no follow up by the person or clinic doing the injection. The patient is simply cut loose or returned to the care of the referring physician, usually a primary care doctor who frequently feels very inadequately prepared for managing the severe pain.

    Second, the conditions that the FDA warned about are indeed rare in terms of their occurrence in a global population. However, the FDA did not include the complication rate of arachnoiditis that occurs in people receiving ESIs for “pain treatment”. Nor did the FDA warnings include the risk of iatrogenic Fungal Innoculation Disease such as the one that affected a potential of 14,000 people when contaminated medications were used.

    The other problem is that the lifetime suffering from failed epidural injections for pain is measured in decades, whereas cancer pain suffering is measured in years. The global suffering that occurs as a result of ESI gone wrong is going to be far more pervasive than cancer pain. The people with such severe pain from ESIs gon wrong are generally hidden from tabulation. Their problems are very real and should not be minimized.