Spinal and epidural blockade are similar in many respects in the anaesthesia they produce, since they both cause major conduction blockade with local anaesthetic agents. Physiologically, the blockade involves the production of a sympathectomy with venous pooling and decreased venous return, causing decreased cardiac output and hypotension. Physiological complications include bradycardia, heart block and, rarely, cardiac arrest. Nonphysiological complications include high or total block from extensive spread of the local anaesthetic agent, and toxic reactions from inadvertent intravenous injection of local anaesthetic during epidural administration. Neurological complications include paraplegia from either haematoma or abscess, arachnoiditis or trauma. Post-dural puncture headache is a persistent problem that is more pronounced in younger patients. Cranial nerve lesions are rarely seen with spinal anaesthesia. This review covers the adverse effects of spinal and epidural blockade and what can be done to prevent and/or treat them. With attention to proper performance and patient selection, spinal and epidural anaesthesia are safe and efficacious options when choosing anaesthetic technique.