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St. Maarten Medical Center
An epidural is used for giving pain relief. It can be used during surgery to supplement a general anaesthetic, and it is continued after the operation for pain control.
The nerves to your lower back pass through an area in your back close to your spine, called the ‘epidural space’. When you have an epidural, an anaesthetist uses a needle to place a fine plastic tube (an epidural catheter) into the epidural space.
Local anaesthetic, and sometimes other pain relief drugs, are put through the epidural catheter. This lies close to the nerves in your back. As a result, the nerve messages are blocked. This gives you pain relief, which varies in extent according to the amount and type of drug given. The local anaesthetic may cause some numbness as well as pain relief.
An epidural pump is used to give pain relief drugs continuously through the epidural catheter. The pain relief lasts as long as the pump is running. When it is stopped, full feeling will return within a few hours.
If your epidural is working properly, you will have better pain relief than with other methods, particularly when you take a deep breath, cough or move about in the bed.
You should need less alternative strong pain relief medicine. This means your breathing will be better, there should be less nausea and vomiting, and you are likely to be more alert.
There is some evidence that other complications of surgery may be reduced, including blood clots in the legs or lung and chest infection. There is also some evidence that you may lose less blood with an epidural, which will reduce your chance of needing a blood transfusion.
It is your choice. Your anaesthetist will tell you if he/she particularly recommends an epidural, and what alternatives there may be. Other pain relief methods use morphine or similar drugs. These are strong pain relief medicines. These drugs have side effects that include nausea and constipation. Some people become confused when using morphine.
Morphine, or other similar drugs, can be given by mouth, by injection or using a pump that you control yourself (patient-controlled analgesia, commonly known as PCA).
Alternatively, there are other ways that local anaesthetic can be given – for example, a nerve block. Every effort will be made to keep you as comfortable as possible.
No. An epidural is not possible for some people. You will need to talk to your anaesthetist if:
Epidurals can be put in:
Your anaesthetist will talk to you about which might be best for
you. The steps for having an epidural are:
The local anaesthetic injection in the skin will hurt briefly. There will then be the feeling of pushing, but usually no more than discomfort as the needle and catheter is inserted.
Occasionally, a sharp feeling, like an electric shock, is felt. If this happens, it will be obvious to your anaesthetist. They may ask you where you felt it. A sensation of warmth and numbness gradually develops. For some types of epidural, your legs may feel heavy and become difficult to move.
Overall, most people do not find these sensations to be unpleasant, just a bit strange. Feeling and movement will return to normal when the epidural is stopped.
People vary in how they interpret words and numbers. This scale is provided to help.
Low blood pressure
It is normal for the blood pressure to fall a little when you have an epidural. Your anaesthetist will use fluids and drugs to correct it.
Inability to pass urine
The nerves to the bladder are affected by the epidural. A catheter (tube) is inserted into the bladder to drain away the urine. This is often needed after major surgery with or without an epidural.
This is a side effect of the pain relief drugs that may be used in your epidural. Anti-histamine drugs help, or the drug in the epidural can be changed.
This is less common with an epidural than with other pain relief methods. It is treated with anti- sickness medicines.
Inadequate pain relief
The epidural may not relieve all your pain. Your anaesthetist or the nurses looking after you will decide if it can be improved or if you need to switch to another pain relief method.
Headaches happen quite often after surgery. It is possible to get a severe headache after having an epidural. This is because the needle used to place the epidural inadvertently punctured the bag of fluid that bathes the spinal cord. A small amount of fluid leaks out, causing a headache. You will be aware of a severe headache that is worse if you sit up and relieved by lying flat. The staff looking after you should alert the anaesthetic team immediately. You may need specific treatment for the headache.
Some drugs used in the epidural can cause slow breathing or drowsiness, which requires treatment.
Nerve damage: temporary
Uncommonly, the needle or epidural catheter can damage nerves. This can give loss of feeling or movement in a large or small area of the lower body. In most people this gets better after a few days, weeks or months.
Nerve damage: permanent
Permanent nerve damage by the needle or the catheter is rare.
An infection can occasionally develop around the epidural catheter. If this happens, it will be removed. It is rare for the infection to spread deeper than the skin.
Convulsions (fits), severe breathing difficulty, permanent paraplegia (loss of use of one or more limbs) or death are very rare.
The risk of complications should be balanced against the benefits and compared with alternative methods of pain relief. Your anaesthetist can give you more information and help you understand the relative risks.
1. Why are you recommending an epidural for me?
2. What are the advantages and disadvantages of an epidural for me?
3. What about the alternatives?
4. Who will do my epidural?
5. Have you often used this type of pain relief?
6. Do I have any special risks?
7. How will I feel afterwards?
8. How will I feel afterwards if I don’t have an epidural?