What Is an Epidural?

An epidural is a type of anesthetic used for pain control during a medical procedure that does not require that a person is put to sleep. An epidural numbs the area being treated. It is a continuous infusion of medication. Sometimes an epidural is given to potentiate (make more effective) a general anesthetic; after the surgery or procedure is over, it is often used for pain control. An epidural is also commonly used for pain control during labor and delivery (childbirth).

An epidural can be inserted:

• When a person is fully awake
• Along with drugs for sedation (those that relax you and make you sleepy)
• During general anesthesia
• In combination with other techniques (such as a spinal analgesia, also referred to as a spinal block)

Provided the epidural is working as it should, it will provide better pain relief than many other methods of pain control.

Your anesthesiologist will talk to you about what type of epidural is best for you.

What Will I Feel When I Get an Epidural?

The initial needle prick in the lower back will sting for a short period of time, next you will feel a sensation of pressure, and perhaps slight discomfort as the needle and catheter are inserted. Sometimes, a sharp, electric shock feeling is experienced (but this doesn’t occur often). When this happens, your anesthesiologist will ask you where you felt this sensation.

Once the medication is administered, a gradual sensation of numbness develops; you may feel a heaviness in your legs which makes it difficult to move them.

Overall, an epidural is experienced by most people as being slightly uncomfortable and as feeling strange, but not severely painful. The effects of the epidural usually wear off within 2 hours after the medication is stopped. When the medication begins to wear off, you may start to feel some tingling in your legs. You may have some bruising and the skin may be sore at the epidural site in your back, this will usually heal and the pain will subside within a day or two.

How Does an Epidural Work?

An epidural is a method of providing anesthesia; it results in a section of numbness from the level of a person’s belly button, to the upper region of the legs. It allows for a person to be awake during a procedure, most commonly, it is known for its pain management properties during labor and delivery. But, an epidural can also be used while a person is asleep during surgery, to boost the effects of general anesthesia, as well as after a surgical procedure, as a source of pain control.

An epidural involves a needle that is placed in an epidural catheter (small, plastic tube) into the epidural space, which is in a person's back, close to the spine. Next, pain medication -such as a local anesthetic or other types of pain relief drugs- is administered through the epidural catheter. Once the medication has been given, it takes approximately 15 minutes to begin to work.

This results in a blockage of nerve messages being transmitted normally, offering pain relief. The level of pain relief depends on which medication is administered via the epidural. Sometimes the pain medication is given with an epidural pump, which provides continuous administration of the drugs, provided the pump is running. Once the pump is turned off, a normal sensation will return within several hours.

Administering an Epidural

The steps involved in the administration of an epidural include:

1.   An IV (intravenous) needle is placed in your arm to administer fluids to counteract side effects of the epidural

2.   You will be positioned on your side or asked to sit up in bed. 

3.   You will be assisted in bending forward and curving your back outward as much as possible.

4.   A small local injection is given to numb the area where the epidural will be inserted.

5.   A needle is used to insert the catheter into the epidural space in the back.

6.   The needle is removed, leaving just the catheter behind.

7.   Medication is administered via the catheter whenever it is needed.

The Pros and Cons of an Epidural

Benefits

There are several benefits of having an epidural, these include:

• Better pain relief than some other modes of pain management, particularly when you cough, deep breathe, or move around after surgery. 
• Less sedating than many other types of pain medication, so you can be more alert.
• Fewer side effects -such as nausea and vomiting- than other forms of pain medication.
• Less pain relief medication is needed, this means there are fewer side effects and your breathing will be less affected.
• Less blood loss which reduces the risk of needing a blood transfusion.

Side Effects of an Epidural

Although epidurals are usually very safe, and the risk of serious side effects is low. As with any other types of medication, there are some side effects that could occur as a result of an epidural, these include:

• Pain in the epidural site: You may experience pain in your lower back where the needle was inserted. This discomfort should subside in a day or two and may last a few days at most. An epidural is not known to cause any type of permanent back pain.
• Low blood pressure: The pain medication given in the epidural may lower the blood pressure and slow the heart rate. You will be given extra fluids in your IV to counteract this antihypertensive (lowering blood pressure) effect. You may also be given medication to help maintain your blood pressure if the IV fluids are not effective.
•  Inability to urinate: Due to the nerves to the bladder being affected by the epidural, a urinary catheter (a tube inserted into the bladder to drain the urine) may be ordered if needed.
• Itching: This can result from the drugs that are used in the epidural, antihistamines can be given to combat itching.
• Nausea: This is usually less prevalent than with traditional pain medications, but it can still occur.
• Headache: This can be caused by inadvertent puncture of the bag of fluid that surrounds the spinal cord, this causes fluid to leak out, which results in a headache; the headache usually gets worse when a person sits up and is lessened when lying in a supine position (on your back).

Uncommon Side Effects

Rare complications or side effects of an epidural include:

• Temporary nerve damage: This can be caused by the needle or epidural catheter insertion causing some damage to the nerves. This can result in loss of sensation in the legs and lower body, but it usually improves with time.
• Permanent nerve damage: This can occur on rare occasions.
• Seizures (convulsions)
• Infection at the catheter site: If this occurs, the catheter is taken out and sometimes antibiotics are given. An abscess could occur, but that is also rare. 
• Severe breathing difficulties
• Death

Contraindications

A contraindication is a specific situation in which a drug, type of surgery or procedure (such as an epidural) should not be used because it could cause harm. Contraindications for an epidural include:

• Taking blood thinners such as warfarin (Coumadin) or heparin
• Having a blood clotting condition
• Having an allergy to local anesthetics
• Having a spinal condition such as a spine that is deformed (an example is scoliosis)
• Having an infection in your back
• A previous spinal surgery (with metal implants in your back)
• Serious side effects from an epidural in the past
• Patient refusal

Be sure to talk to your anesthesiologist about any of these issues before getting an epidural.