An epidural is a form of regional anesthesia that involves injecting a small amount of anesthetic into the epidural space, which surrounds the spinal cord. This procedure is typically used during childbirth, surgery on the lower abdomen or legs, or to manage chronic pain. The anesthetic numbs the nerves in the area, providing pain relief without causing the patient to lose consciousness.
Epidurals are typically administered by an anesthesiologist, who will use a small needle to inject the anesthetic into the epidural space. The procedure itself is relatively quick, taking around 15-20 minutes to complete. During the procedure, the patient will be seated or lying down and will be asked to remain still to ensure the needle is inserted into the correct location.
After the epidural is in place, the patient may feel numbness or tingling in the legs, but should not feel any pain. The anesthetic will take effect within a few minutes and will last for several hours.
It is important to note that epidurals do have some risks and potential side effects, such as a headache, backache, or a drop in blood pressure. However, these risks are generally considered to be low and epidurals are considered to be a safe and effective form of pain management.
To position the patient for an epidural, they will typically be asked to sit on the edge of the bed and lean forward, with their back rounded. This position allows the healthcare provider to access the correct area of the spine more easily.
Common drugs used for epidural anesthesia include lidocaine, bupivacaine, and fentanyl. These drugs work by blocking the transmission of pain signals to the brain.
Side Effects :
Epidurals are usually safe, but as with all medical treatments, side effects and complications can sometimes happen.
1- Low blood pressure
It's normal for your blood pressure to fall a little when you have an epidural. Sometimes this can make you feel sick.
Your blood pressure will be closely monitored. If necessary, fluids and medicine can be given through a drip to keep your blood pressure normal.
2-Loss of bladder control
After having an epidural, you may not be able to feel when your bladder is full because the epidural affects the surrounding nerves.
A catheter may be inserted into your bladder to allow urine to drain away. Your bladder control will return to normal when the epidural wears off.
3-Itchy skin
This can be a side effect of the pain-relief medicines that may be used in your epidural.
Medicine can be given to help the itching, or the medicine in the epidural can be changed.
4-Inadequate pain relief
The epidural may not block all your pain. You may be offered an extra, or alternative, pain relief method.
5-Headache
A severe headache can happen if the bag of fluid that surrounds your spine is accidentally punctured. You may need specific treatment for the headache.
A procedure known as a blood patch may be used to seal the puncture. It involves taking a small sample of your blood and injecting it into the puncture.
When the blood thickens (clots), the hole will be sealed and your headache will stop.
Not all headaches from an epidural require a blood patch. Your anaesthetist will discuss your options with you.
6-Slow breathing
Occasionally, some medicines used in an epidural can cause slow breathing or drowsiness.
You will be monitored closely to look for this, and it can be treated easily.
7- Temporary nerve damage
The needle or epidural tube can damage nerves, but this is uncommon. Nerve damage can cause loss of feeling or movement in parts of your lower body.
The most common symptom is a small, numb area with normal movement and strength. This usually gets better after a few days or weeks, but can sometimes take months.
8- Infection
An infection can sometimes happen around the skin next to the epidural tube.
It's rare for the infection to spread. Antibiotics may be necessary or, rarely, emergency surgery.
9- Permanent nerve damage
In rare cases, an epidural can lead to permanent loss of feeling or movement in, for example, 1 or both legs.
The causes are:
- direct damage to the spinal cord from the epidural needle or catheter
- infection deep in the epidural area or near the spinal cord
- bleeding in the epidural area, causing pressure on the spinal cord
- accidentally injecting the wrong medicines into the epidural catheter
These are rare events, and anaesthetists have extensive training to reduce the chances of these complications.
Nerve damage can also happen for other reasons during surgery, which are unrelated to the epidural.
