Epidural Considerations and Contraindications

Last updated: February 9, 2026

#1 contraindication → patient refusal. Do not force it.

Infection
Absolute: bacteremia/sepsis, meningitis (LP’s are done all the time, the issue is the administration of anesthetic medication), local infection at needle site insertion.
Relative: resolving systemic infection, remote infections, certain immunocompromised states.

Hematological
Absolute: severe thrombocytopenia (< 70k is a general cutoff to consider risks/benefits), active coagulopathy (abnormal INR, abnormal PTT).
Relative: 70k-100k, hematologic malignancies.
Hemophilia A/B → must time recombinant factor to be one hour prior to placement and removal of epidural.
Platelets → consider whether quantitative consumption, qualitative issue, idiopathic or consumptive etiologies.
Heparin SC high dose → hold 12 hr, normal coags.
Heparin SC low dose → hold 4-6 hr or normal coags.
Clopidogrel → hold 5-7 days for washout.
Aspirin or NSAIDs → no hold time needed.

Neurological
Multiple sclerosis → they get LP’s regularly. So not the placement, but medication administration could cause a flare-up, but studies seem to indicate otherwise.
Chiari → try to get neurosurgical clearance prior. But if operated on, likely fine. If uncorrected, try to view imaging. Primary concern is avoiding herniation. Patients without increased ICP or severe symptoms, epidural likely safe.
Non-communicating hydrocephalus → concern for herniation.