Complications of Thoracic Segmental Spinal Anesthesia

Neurological and Cardiovascular Complications

• Regional anesthetic techniques are contraindicated in patients at risk of neuraxial hematoma formation due to thienopyridine antiplatelet therapy, low-molecular-weight heparins, or clinically significant anticoagulation, as stated by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, representing a Class III recommendation (should not be performed) 1
• The risk of neuraxial hematoma is particularly concerning in thoracic approaches where epidural space is narrower and spinal cord vulnerability is greater 2
• Epidural, spinal, or subdural abscess can occur following neuraxial techniques, and meningitis represents a serious infectious complication requiring strict aseptic technique 2, 3

Cerebrospinal Fluid-Related Complications

• Spinal headache occurs from CSF leakage through the dural puncture site, and persistent CSF leaks may require epidural blood patch for resolution 3
• Subdural hematoma has been reported after procedures involving spinal fluid drainage, though this is more commonly associated with therapeutic CSF drainage rather than diagnostic puncture 3

Critical Contraindications and High-Risk Scenarios

• The American College of Cardiology/American Heart Association (ACC/AHA) guidelines state that regional anesthetic techniques should not be used in patients with active anticoagulation or antiplatelet therapy due to catastrophic bleeding risk, particularly relevant for patients with cardiovascular comorbidities requiring antiplatelet or anticoagulant medications 1, 4