Consent

When consenting a patient for any procedre you need to tell them enough information for them to make and informed decision.

This includes:

Try framing risks in terms of everyday events, e.g. traffic accidents. This makes it easier for patients to put things in perspective.

Be aware that your own biases and perceptions may impede any rational discussion about risk.

The complication and success rates of epidurals varies greatly in the literature. This means we don't know the true rates.

The following are some statistics that you can that you can use when consenting a patient. They are composed from two sources, "Acute Pain Management: Scientific Evidence 2005" and "Consent and Anaesthesia, Anaesthesia 2003 Oct;58(10):962-84 Jenkins, Baker". The later is highly recommended for further reading on this topic.

 

Failure of Treatment

Up to 22% of epidurals will not last as long as expected due to dislodgement, inadequate analgesia or sensory or motor deficit.

Post Dural Puncture Headache

Up to 1 in 100 patients

Patients less than 50 years old and pregnant patients are at greatest risk

Blood patch is successful in 70-100% but headaches recur in 30-50%

Neuropraxia

Between 1 in 1000 and 1 in 10 000

Permanent Neurological Injury

1 in 1 000 to 1 in 3 000

Epidural Haematoma

Between 1 in 10 000 and 1 in 150 000 depending on study and population

Epidural Abscess

1 in 2 000 to 1 in 7 500

More likely the longer the catheter is in situ

Paralysis

1 in 100 000

Equipment