Contraindications
Contraindications are rarely absolute. Speak to your consultant if you are unsure.
Patient Refusal
Coagulopathy
Epidural haematomas can cause potentially catastrophic spinal cord compression.
Anticoagulants and anti-platelet drugs
Read the ASRA consensus statement on managing anticoagulation and regional anaesthesia.
Thrombocytopaenia
There is no universally accepted platelet count above which regional anaesthesia is considered safe although 80 000 /mm^3 is often quoted.
There is no widely available test of platelet function.
Bleeding Disorders
Need to manage according to specific disorder often in conjuction with a haematologist.
Sepsis
Systemic sepsis or sepsis at the site may increase the risk of epidural abscess. The decision to perform an epidural will depend on the indication, the patient's clinical condition and available alternatives to regional anaesthesia.
Commonly women in labour will have a fever. There is no evidence of increased epidural abscess in these patients and no guidlelines on the use of regional anaesthesia.
Fixed Cardiac Output states
Decision to perform regional will depend on severity.
Aortic Stenosis
Mitral Stenosis
Pulmonary Hypertension
Hypertrophic Obstructive Cardiomyopathy
Haemodynamic Instability
Causing sympathetic block may worsen instability.
Raised intracranial pressure
Accidental dural puncture may precipitate coning.
Abnormalities of the Spinal Column
Previous surgery (e.g. Harrington Rods) may make epidural insertion difficult or impossible and increases the risk of complications such as dural puncture.