The term epidural refers to a method of pain management that involves injecting drugs through a catheter inserted into the epidural space in the spinal canal. This injection causes a general loss of physical sensation—especially pain—by blocking transmission of signals through the spinal cord. Epidural is most commonly administered during childbirth, although it is also used for other types of surgical procedures.
The Epidural Procedure
To begin the epidural procedure, the patient may be in any position—seated, prone, or lateral (lying on their side). The point on the spinal cord at which the epidural is placed depends on the location of the pain or the site of the surgery to be performed. The operator carefully inserts the needle until he or she feels a clicking sensation indicating that the tip of the needle has entered the epidural space. In recent years it has also become common to use fluoroscopy or ultrasound to ensure correct placement of the needle.
After the needle has been placed in the epidural space, a catheter is threaded through it, and the needle is withdrawn. The catheter is then secured with adhesive tape, and an anesthetic is administered through it. When the surgical procedure is complete, or when childbirth is over with, the catheter is removed as soon as the patient is able to take oral pain medications.
Benefits of Epidural
Epidural generally provides extremely rapid pain relief. This is important for expectant mothers facing the often excruciating agony of childbirth. Unlike other methods of pain management, epidural does not require that extraordinary measures be taken to protect the baby from possibly dangerous drugs administered to the mother.
Side Effects of Epidural
Epidural is not without some drawbacks. In some cases the physician attending the delivery may need to resort to the use of oxytocin in order to stimulate contractions in the mother’s uterus. Deliveries tend to take longer when an epidural has been administered, and the likelihood increases that a C-section delivery will be necessary. If the patient has previously had spinal surgery, there is a chance that scar tissue left over from the surgery may inhibit the spread of the medication. Depending on what drug is used and in what dosage, the effects of an epidural can last for a few minutes or for several hours, during which time the patient will be immobilized.
Epidural can also sometimes cause fever and nausea, and in some cases the patient suffers a severe headache lasting several days (or in rare cases, for weeks or months). In most cases this post-dural puncture headache (PDPH) is nothing to be concerned about, although you should contact your doctor if there is any sudden change in symptoms—for example, the headache suddenly becomes much worse whenever you lie down.
Risks of Epidural
While epidural is generally considered a safe, low-risk procedure, there are risks, however negligible. For one, the procedure can in rare cases cause some difficulty breathing. Some of the nerve signals that normally are automatically transmitted to the heart may be suspended, which can cause the mother’s blood pressure to become dangerously low. In the very unlikely event that the epidural needle and catheter are accidentally inserted into a vein instead of into the epidural space, there is a risk that an incorrect drug dosage will be delivered.
Am I a Candidate for Epidural?
While it is tempting to think that epidural is an easy fix for the pain of childbirth, the truth is that not every woman is a candidate. In some cases the procedure fails to achieve the necessary effect, and this failure is statistically more likely if you have a history of opiate abuse, or even if you have previously had children (especially if an epidural was used). Obesity can also be a factor in unsuccessful epidural procedures, as can a history of previous failures of epidural anesthetic.
It is also important not to arrive too late to the hospital if you hope to have an epidural for your pain. If your cervix has dilated to more than seven centimeters, you may not be a candidate for an epidural.
Questions to Ask Your Doctor About Epidural
- Am I a good candidate for an epidural?
- How long will the epidural take to begin working?
- How long will the effects of the epidural last?
- Will I feel any pain at all?
- Does it hurt when the needle goes in?
- Is there any danger that the epidural could harm my baby?
- If I am not a good candidate for an epidural, what alternatives do I have for coping with the pain?