Epidural Anesthesia

Epidural anesthesia is a method used to eliminate pain during certainprocedures or surgeries. In this form of anesthesia, medication is injected inside the spinal column with aneedle or thin tube.

Who is a candidate for the procedure?

An epidural, as the procedure is commonly called, is usually used forprocedures performed below the rib cage. It is often the preferred way toreduce pain during childbirth. It can also be used for pain control aftersurgery or childbirth. Sometimes an epidural is used instead of general anesthesia if a person is veryweak or sick.

How is the procedure performed?

A needle or special tube is inserted through the skin of the back until itenters the spinal column. Medication can then be injected into the spinalcolumn. It is injected just outside the sac that contains the spinalcord. The medication acts on nerves that come from the spinal cord and carrypain messages to the brain.

An epidural is different from spinalanesthesia, a procedure in which the medication is injected insidethe sac that contains the spinal cord. Epidurals are usually preferred forchildbirth and are often better for pain control. Spinals require lessmedication and work faster, but they are more likely to cause headaches and low bloodpressure.

Medication for epidural anesthesia may be given as a one-time injection with aneedle. Another method is to put a special tube into the space around the sacinside the spinal column. This tube stays in place. If the surgery lasts a longtime or pain medication is needed after surgery, more medication can be giventhrough the tube.

The medication stops the sensation of pain and paralyzes the muscles, usuallyonly below the rib cage. The amount of medication used can affect how far thenumbness and paralysis extend through the body. The individual is generally awake duringthe procedure. Sedatives can be given if the person has anxiety.

Careful monitoring is done during the procedure. The oxygen levels in theblood, pulse, blood pressure, and other functions are monitored. Fluidsare usually given through an intravenousline (IV) to prevent dehydrationand low blood pressure. If a tube isinserted into the spinal column, it is removed when no longer needed.

What happens right after the procedure?

A person is taken to the surgery recovery room after the procedure. If sedatives were used, theindividual may feel groggy for a few hours. Pain medication can be given asneeded. The pain medication can be given through an intravenous line in the arm or hand, or through the tube in thespinal column if one was used.

The numbness and paralysis usually go away within a few hours. The individualis asked to lie flat on his or her back for an hour or more after theprocedure. This can help prevent problems with the injection site in the back.A short hospital stay may be needed to recover from major operations. In somecases, the person is able to go home later the same day. If sedatives wereused, someone must drive the person home. After childbirth, awoman usually stays in the hospital at least overnight.

What happens later at home?

A bandage is usually placed over the area on the back where the needle or tubewas inserted. The bandage should be left on for at least 24 hours and the area shouldbe undisturbed. Usually no other care is needed at home for the epiduralanesthesia, but the person may need care because of the surgery.

What are the potential complications after the procedure?

The most feared complication of anesthesia is death. This occursin roughly 1 out of every 10,000 people who have epidural anesthesia. It is notpossible to predict who will have this type of severe reaction.

The most common problem after an epidural is a headache. This usually goes away within 24 hours and oftenresponds to pain medication. Sometimesanother injection in the back is needed to help the pain. Nausea is also fairly common in the first few hours afterthe procedure.

Blood pressure can drop very low during an epidural, but thisusually doesn’t cause problems. Allergicreactions, arrhythmias orirregular heartbeats, and seizures arerare complications of an epidural. Bleeding and infection can occur at the siteof the needle injection. Other side effects may occur, depending on themedications used.

The American Society of Anesthesiologists recently issued a warning about thepotential side effects and interactions of herbal remedies with medications used before, during, and after surgery.The group recommends discontinuing all herbal remedies and supplements at leasttwo weeks before planned surgery.