Side Effects of Epidural Bupivacaine | Oxford University Hospitals NHS Foundation Trust

Local anaesthetic side effects are concentration dependent so when 0.25% bupivacaine was used for post-operative analgesia, hypotension and motor block were common. We now use bupivacaine 0.1% which doesn’t provide sufficient analgesia alone, so is combined with fentanyl ( Side Effects of Epidural Fentanyl).

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Hypotension cannot simply be attributed to epidural analgesia, so other causes should be sought. Most post-operative patients with hypotension are hypovolaemic with a poor urine output. Look for large drain outputs or high NG aspirates, consider hidden blood losses, ask the patient if they feel thirsty.

In very rare cases of epidural catheter migration into the subdural or subarachnoid space, severe hypotension may occur, however, this will resolve as soon as an epidural infusion is stopped. If the blood pressure does not rise within 15minutes, then the epidural is unlikely to be the cause.

If you are concerned about a patient with an epidural and hypotension, bleep the pain team or, out of hours, the on-call anaesthetist for advice. ( Useful Contact Details within OUH)

Motor block is unusual with 0.1% bupivacaine, particularly if the epidural is sited in the thoracic region, so must precipitate urgent review and initiation of the SOS flowchart ( SOS - Epidural and Leg Weakness ), due to concerns over an epidural haematoma or abscess causing cord compression.

The risk of permanent paralysis can be reduced by swift evacuation of the haematoma or abscess so speed to diagnosis or exclusion is crucial.

If you are concerned about a patient with an epidural and leg weakness, bleep the pain team or (out of hours) on-call anaesthetist for advice ( Useful Contact Details within OUH).