Vasovagal reaction

• Allergic reaction to injected medications or topical antiseptic

• Infection: Superficial infection or deep infection (epidural abscess) may occur. Adrenal suppression by corticoste-roids may unmask systemic infection

• Bleeding: Hematoma may develop in superficial tissue sites or in the epidural space

• Dural puncture and subarachnoid injection: Spinal headache may occur due to spinal fluid leak secondary to inadvertent dural puncture. Frequently, the dural puncture site seals by itself with bedrest. Epidural blood patch is the treatment for persistent spinal headache. Injection of medication intended for the epidural space into the subarach-noid space may lead to respiratory depression, arachnoiditis, and pain

• Intravascular injection: May lead to spinal cord infarction or anesthetic toxicity (seizures, cardiac arrest, death). The advantage of the transforaminal approach due to its delivery of the injectate to the anterior epidural space must be weighed against the potential risk of spinal cord or brain infarction due to unrecognized intravascular injection, which is less likely to occur with the caudal or translaminar approaches

• Neurologic complications: May occur as a result of direct penetrating trauma to spinal nerves or the spinal cord, infarction due to intravascular injection into a radicular artery, ischemia resulting from neural compression by hematoma, or neurotoxicity secondary to injected medication

• Miscellaneous complications: Pneumothorax (following lung injury during thoracic or lower cervical injections) or bladder dysfunction (due to blockade or sacral nerve roots)

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