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Anesthesia

Extreme jolt of pain during epidural

05/30/2007

Question:

Three years ago I had surgery for removal of a large ovarian cyst. An epidural was planned, and when I was prepped and on the OR table, leaning over as the needle was being inserted, I felt an electrical-like jolt of pain-(severe!!!!!), and I remember falling over on my side onto the table but that`s all. Next thing I remember I was waking up in recovery. Apparently after this happened a general anesthetic was administered instead, but next day there were large bruises on my left upper arm almost in the shape of fingerprints, as if I was grabbed to prevent falling off the table. My question is, is this common and what likely happened during the epidural?

Answer:

The best way to establish what happened while you were in the operating room is to ask the doctors who took care of you. Failing that, you could ask to review the hospital records, which is your right. (Some institutions may charge for the cost of copying those records, which is their right!)

One possibility is that the epidural needle went somewhere it was not intended to go. A very sharp, severe pain might have been due to contact between the needle, and a nerve. In such circumstances, the needle would be withdrawn, and the anesthesiologist might very well choose not to subject the patient to further unintended pain or trauma. A general anesthetic is then a satisfactory alternative.

How common is this? Unfortunately even in the best hands, regional anesthesia (including spinal and epidural) is sometimes unsuccessful. That's why there is always a "Plan B". The exact incidence of nerve injury in association with spinals or epidurals is of the order of one in every several thousand, with almost all of those recovering over a period of weeks to months.

Epidurals are almost always done in awake patients. You might be able to guess why. Had you been asleep during the insertion of the needle you would not have reacted to the needle. Pain, and the reaction to pain allow the anesthesiologist to recognize the possibility of imminent injury to a nerve or other structure, withdraw the needle, and avoid serious or permanent harm.

Although the marks on your upper arm might have resembled fingerprints, they were more likely due to the imprint of the blood pressure cuff. During a surgical procedure you will have your blood pressure measured repeatedly every 2-5 minutes. This sometimes causes bruising.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University