Anaesthetic, epidural

Page last reviewed: 13/07/2011

An epidural is an injection that numbs the lower half of your body. This includes your abdomen (stomach), pelvic area and legs.

An epidural can either:

  • stop you feeling any pain (analgesia), or
  • stop you feeling any sensation at all (anaesthetic).

The epidural anaesthesia is a form of medication that is carefully injected by a specialist into the 'epidural space' in your spine. The medication blocks the nerve roots in your spine that lead to the lower part of your body. This numbs the area.

The extent of the numbness depends upon the type of anaesthesia medication that the specialist uses and how much they inject. The feeling in your body returns completely once the medication has worn off.

Epidural


An epidural is an anaesthetic injection given into the epidural space that surrounds the spinal cord, especially during labour, to numb the lower half.

Anaesthetic


Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.

Pain


Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Page last reviewed: 13/07/2011

Epidurals have many significant uses. They can provide:

  • pain relief during natural childbirth,
  • pain relief after surgery,
  • anaesthesia during a Caesarean section, and
  • anaesthesia during other types of surgery on the lower part of your body.

The main advantage of epidural anaesthesia is that it can completely block pain while allowing you to remain conscious. See the Advantages page for more information about this.

Page last reviewed: 13/07/2011

Epidural anaesthetics are carried out by experienced anaesthetists and other healthcare professionals, such as orthopaedic surgeons and specialists in managing chronic pain.

Before being given an epidural anaesthetic, you will be asked either to lie on your side, with your knees drawn up and your chin tucked in, or to sit on the bed or a chair and lean forward.

These positions open the spaces between the bones of your spine (vertebrae) so that the needle that is used for the epidural can fit through them.

You will be given an injection of local anaesthetic to numb the area of skin where the epidural will be injected. To give the epidural anaesthetic, a hollow needle is then passed into the area that has been numbed.

A thin, plastic tube is passed through the middle of the needle and into the epidural space. The anaesthetic is then passed through the tube. You will be asked to stay still while the epidural anaesthetic is being injected.

After the needle is taken away, the plastic tube stays in the epidural space and is held in place with adhesive tape.

 

What does an epidural feel like?

 

An epidural injection may feel a little bit uncomfortable, but the local anaesthetic should prevent it from being painful. You may feel a 'pushing' sensation on your back while the needle and tube are being inserted.

You should tell your healthcare professional if, while having an epidural injection, you feel a 'pins and needles' sensation or a sharp tingle in one of your legs. If you do, the needle may need to be repositioned.

After the epidural injection, you may be asked to lie flat. The anaesthetic will usually start to work after 10-20 minutes. Your legs will be numb, heavy and difficult to move, and you won't be able to walk around.

The nerves in your bladder are also likely to be affected by the anaesthetic, so you wont know when you need to go to the toilet. A small, plastic tube (catheter) will be passed into your bladder to drain the urine when your bladder becomes full.

 

How long does an epidural anaesthetic last?

 

For short operations, a single epidural injection is usually given. After a few hours, your body will break down the anaesthetic and feeling will gradually begin to return to your legs.

For longer operations and childbirth, the plastic tube is often left in the epidural space so that the anaesthetic can be topped up. The tube is usually connected to an automatic pump, so that the medication can be topped up every hour in order to keep your lower body numb.

This pump can also be used to provide pain relief for several days after surgery.

Page last reviewed: 13/07/2011

Epidural anaesthesia is a safe and reliable method of pain relief but there can be some side effects.

Low blood pressure. Low blood pressure is treated with medication, or by giving fluids through a drip. Your blood pressure will be regularly checked during the procedure.

Backache. After having an epidural some people experience back pain that lasts for several weeks or months in the area where the injection was given. This sometimes happens because the back muscles relax after the epidural anaesthetic has been inserted. Backache is also experienced after childbirth by many women who didn't have an epidural.

Inability to move your legs. Following an epidural, you will be unable to move your legs. This will only last until the anaesthetic wears off.

Itchy skin. Some of the medication that is used for epidurals can cause itchiness. Your healthcare professional will be able to change your medication in order to deal with this.

Uneven pain relief. Sometimes, the epidural anaesthetic doesn't spread evenly around your spinal cord, and you'll have less feeling in one side of your body than the other. A top-up dose can usually fix this.

Vomiting. Vomiting sometimes happens after an epidural anaesthesia. However, there is less chance of vomiting than there is after  a general anaesthetic.

Loss of bladder control. After an epidural, you can't usually tell whether you need to pass urine so you'll have a catheter (a thin tube) inserted into your bladder so that your bladder to drain it when it's full.

Side effects of epidural anaesthesia during childbirth

In addition to the side effects listed above, the following side effects sometimes affect women who have an epidural during labour.

Labour can take longer. If you have an epidural during labour, the final stage of labour can take longer if you're unable to feel your contractions. There is no need to worry if you can't feel the contractions as your midwife will tell you when to push.

Medical intervention. If you have an epidural during labour, you will need medical intervention. This is important because your baby's heart rate and your blood pressure will need to be monitored throughout the procedure in order to make sure that you are both doing well.

Assisted birth. With an epidural, there is a slightly increased chance that you will need to have an assisted birth using a ventouse suction cap or forceps. If assistance is needed, your midwife will discuss this with you.

You may have an 'inactive' birth. If you have an epidural, moving around can sometimes be very difficult, or impossible. You will require assistance from your midwife, or birthing partner. You may be unable to give birth in the position you had planned to.

Rare side effects

Severe headache. Occasionally, during epidural anaesthesia, there is a small leak of fluid from the spinal cord that causes a severe headache. This can last for a week (or sometimes longer) and you may need to remain lying down until the puncture has healed.

Infection. Following an epidural, an infection can sometimes occur at the site of the injection. However, this is unlikely because the needle is sterile and your skin is cleaned thoroughly before the procedure is carried out.

Complications

Serious complications of epidural anaesthesia are rare, but complications include:

  • fits and breathing difficulties,
  • patches of numbness that can last for up to three months, and
  • paralysis (a complete loss of sensation and movement). This is extremely rare.

Page last reviewed: 13/07/2011

Following epidural anaesthesia, your doctor or nurse will make sure that the numb area of your body is protected from pressure and injury until the feeling returns.

It usually takes a couple of hours for feeling to return to the area of your body that is numb. As feeling returns, you may experience a slight tingling sensation on your skin as the anaesthetic begins to wear off.

If you start to feel any pain, tell the doctor or nurse who is treating you. They can give you medication to help control it.

As the epidural anaesthetic wears off, you may need some help getting out of bed.

You can normally drink fluids within an hour of the operation and may be able to eat some light food. The doctor or nurse will be able to advise you about this.

Glossary

Numb
Numbness refers to a lack of sensation in a part of the body.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Epidural
An epidural is an anaesthetic injection given into the epidural space that surrounds the spinal cord, especially during labour, to numb the lower half

Page last reviewed: 13/07/2011

Childbirth

These are the main advantages of having an epidural during childbirth:

  • It provides complete pain relief without making you feel confused or drowsy.
  • It can be topped up if you need surgery (a Caesarean).
  • A low-dose (mobile) epidural will allow you to feel your contractions.
  • It immediately calms the baby if your labour pains were previously causing stress.
  • It can allow you to have a rest, giving you more energy for pushing during the final stage of the birth.

Surgery

The main advantages of having an epidural anaesthetic, as opposed to a general anaesthetic, during surgery include:

  • You can't feel any pain but you remain conscious, which speeds up your recovery time.
  • You can eat, drink, and move around more quickly.
  • You are less likely to experience the side effects of a general anaesthetic, such as vomiting and blood clots in the leg.
  • It's easy to top up the epidural to give you effective pain relief after the operation.

Glossary

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Epidural
An epidural is an anaesthetic injection given into the epidural space that surrounds the spinal cord, especially during labour, to numb the lower half

Page last reviewed: 13/07/2011

Before having an epidural, your GP, anaesthetist or other healthcare professional will discuss your health and medical history with you.

Epidurals may not be suitable for you if you have conditions that affect the nervous system, or if you have blood clotting problems or back problems.

It is also recommended that extra care be taken with an epidural if you've previously had a Caesarean section, or if there are problems with the placenta.

Glossary

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Epidural
An epidural is an anaesthetic injection given into the epidural space that surrounds the spinal cord, especially during labour, to numb the lower half.
Caesarean section
A Caesarean section is an operation to deliver a baby by cutting through the mother's abdomen to open the womb.

Page last reviewed: 13/07/2011

Epidural anaesthetic can be used for several different operations and procedures.

It can be a good alternative to a general anaesthetic because you stay awake during the operation and are therefore able respond to the doctors and nurses who are treating you.

Many people who have epidural anaesthesia find that they experience less nausea and vomiting than during general anaesthetic. It also takes less time to recover from the effects of the anaesthetic.

As well as providing pain relief and anaesthesia during childbirth, epidural anaesthesia is also sometimes used during certain operations. For example, it may be recommended for:

  • hip and knee surgery,
  • surgery to reconstruct arteries in the lower legs,
  • amputation of the lower limbs,
  • operations on the genitals or bladder,
  • surgery for varicose veins, hernias and piles (haemorrhoids), and
  • pain relief following surgery that was carried out under general anaesthetic.

Epidurals during childbirth

Some women have an epidural anaesthetic during childbirth. Your doctor or midwife will tell you if they think you need an epidural, although the final decision is up to you.

An epidural is usually recommended in the following cases:

  • During particularly painful, or prolonged, labour,
  • when there is a risk that an operation may be required,
  • for the delivery of twins or triplets,
  • if you have a medical disorder that makes general anaesthesia dangerous, 
  • for Caesarean delivery, and
  • for delivery that requires using forceps, or a ventouse delivery (where a suction cap is attached to the baby's head to help with the delivery).

Low-dose (mobile) epidurals

Low-dose epidurals are also known as 'mobile' epidurals. These are sometimes given to women during labour. A smaller amount of anaesthesia is given so that sensations in the nerves are not completely blocked.

Having some sensation in your legs and abdomen means you'll be able to move around to a certain degree. For example, it may be possible for you to walk a short distance if you're completely supported by your midwife.

A low-dose epidural is a way of giving you a brief rest from the pain during early labour. It also allows you to sleep. You should be able to feel the contractions and the need to push during the final stage of labour.

If you have a higher-dose epidural, you will not feel your contractions and your midwife will need to tell you when to push.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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