There is no evidence from studies that epidurals cause long term backache.

A randomized controlled study of epidural versus non-epidural analgesia in labour showed no difference in long term outcome. There are no differences in the incidence of long term low back pain, disability, or movement restriction. There is no reason to suppose these results are not applicable to non-labour epidurals.

Needle or catheter breakage. Epidural and spinal needles are unlikely to break in normal, careful use. A spinal needle should always have its obturator in place when being advanced. In the event that any neuraxial block needle does break and cannot be removed, referral for neurosurgical review is indicated.

Similarly, epidural catheters do not break in normal circumstances. There are two times of risk:

• If catheter withdrawal is attempted through the epidural needle. The sharp bevel can shear the soft catheter. As a rule, the catheter should never be withdrawn with the epidural needle in the patient
• At catheter removal. Gentle traction only should be needed for withdrawal. Back flexion may facilitate withdrawal. In the event that the catheter cannot be removed, senior anaesthetic help should be called

In the event of shearing or breakage of a needle or catheter, a neurosurgical opinion should be sought.