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Epidural Anaesthesia

General Anaesthesia

This page explains what epidural anaesthesia is, how it works and when you may need it. It explains the benefits and risks of having epidural anaesthesia. Included is information you will need to prepare for your procedure.

What is epidural anaesthesia?

Epidural anesthesia is a type of regional anesthesia that blocks pain in a particular region of the body.

The epidural space is a potential space that exists between the outermost layer of the spinal canal, the ligamentum flavum  and the dura mater, which is the tough outer covering of the spinal cord and brain. This space runs along the entire length of the spine, from the base of the skull to the sacrum 

Within this space, you’ll find fatty tissue and a network of blood vessels, as well as small amounts of lymphatic fluid. One of the most common uses of accessing the epidural space is to administer epidural anesthesia, particularly during childbirth. The anesthesia works by blocking the transmission of pain signals through the nerves in the spinal cord, thereby providing significant pain relief. When performing an epidural injection, a needle is inserted into the back, through the ligamentum flavum, and into the epidural space, where the anesthetic medication is then delivered.

When is epidural anaesthesia used?

Epidural anaesthesia is commonly used for:

Pain relief during labour and childbirth.

Surgical procedures

as an alternative to general anaesthesia, especially for surgeries involving the lower body.

Postoperative pain management

to provide continuous pain relief after surgery.

Chronic pain management

such as back pain, through epidural steroid injections.

Benefits of epidural anaesthesia

Effective pain relief

Epidural anaesthesia provides significant pain relief without affecting your mental state.

Reduced need for opioids

It can reduce the need for opioid painkillers, which have side effects and potential for addiction.

Mother's comfort during childbirth

It allows mothers to remain awake and alert during delivery, even for caesarean sections.

Faster recovery

By managing pain effectively, it can help speed up recovery times.

Pre-operative Consultation

Your anaesthetist will meet you in the ward or the theatre reception area before your procedure. A medical history will be obtained, and a physical examination performed. During this visit, the anaesthetist will determine if epidural anaesthesia is safe for you and discuss the procedure and relevant side effects or possible complications. Please inform the anaesthetist of any medical illnesses and chronic medication you take. It is vitally important to mention any bleeding disorders or if you are taking a blood-thinning drug such as Warfarin, Aspirin, Ecotrin, Pradaxa, Clexane or any others.

Common Questions about Epidural Anaesthesia

How is an epidural administered?
  • Preparation: An intravenous cannula will be placed to administer fluids and any required intravenous drugs. Monitors for heart rate and rhythm, blood pressure and pulse oxygenation will be attached when applicable. The patient is positioned either sitting up or lying on their side with their back curved. The patient’s back will be cleaned with an antiseptic solution. 
  • Local anaesthetic: A small injection of local anaesthetic is given to numb the skin.
  • Insertion: A specialised needle is carefully inserted into the epidural space in the lower back. 
  • Catheter placement: A thin plastic catheter is threaded through the needle and left in place. This catheter will remain until the epidural anaesthesia is stopped.
  • Medication delivery: Medication is administered through the catheter either as a single dose or continuously via a pump.
  • Sometimes an epidural is placed in a patient who is already asleep, for instance in the paediatric population.
What can you expect to feel during placement and after?

During epidural anesthesia, many patients experience varying sensations, but here’s a general idea of what you might feel:

  • Initial Injection: You’ll feel a small pinch or sting when the anesthetic is first injected to numb the area where the epidural catheter will be placed.
  • Placement of the Catheter: As the catheter is inserted into the epidural space, you might feel pressure in your lower back. Some people also describe a brief, tingling sensation or an electric shock-like feeling down one leg or both legs as the catheter gets close to the nerves.
  • Onset of Numbness: Once the anesthetic starts working, you’ll begin to feel numbness and warmth spreading through your lower body, including your belly, legs, and pelvic area. This can be a bit strange, but it’s generally not painful.
  • Reduced Pain: As the anesthesia takes effect, you should feel significant pain relief in the numbed areas. You might still feel some pressure or touch, but the sharp pain should be minimized.
  • Movement: Depending on the dose and type of medication used, you might experience limited movement in your legs, or they may feel heavy or weak. You should still be able to move to some extent, though full mobility may be affected.
  • Side Effects: It’s possible to experience side effects such as shivering, itching, nausea, or a drop in blood pressure, which your medical team will monitor and manage.

Remember, your healthcare team will be there to guide you through the process and ensure you’re comfortable. If you have any specific concerns or questions, it’s always best to discuss them with your doctor or anesthesiologist.

When you shouldn't have an epidural
  • Patient refusal: You must agree to the procedure.
  • Blood clotting problems: If your blood doesn’t clot properly, it can be risky.
  • On blood thinners: If you’re taking medication that affects blood clotting.
  • Infection at the injection site: If there’s an infection on your skin where the needle would go.
  • High pressure in the brain: Conditions that increase brain pressure can be dangerous.
  • Very low blood volume: If you’ve lost a lot of blood.
When to Be Cautious
  • Difficulty staying still: You need to remain still during the procedure.
  • Pre-existing nerve problems: If you already have nerve issues.
  • Certain heart problems: Conditions that affect how your heart pumps blood.
  • Spinal abnormalities: Issues with your spine that could make the procedure tricky.
  • Low-dose blood thinners: Timing might be important to avoid complications.
Complications of Epidural Anaesthesia
  • Low Blood Pressure (Hypotension): This is a common side effect due to the blockade of the sympathetic nerves. It can cause dizziness, nausea, and a feeling of lightheadedness2. It is usually managed with fluids and medications to maintain blood pressure.
  • Headache: A severe headache can occur if the needle accidentally punctures the dura mater (the outer membrane of the spinal cord), leading to a leakage of cerebrospinal fluid. This is known as a post-dural puncture headache and can be treated with rest, hydration, and sometimes a procedure called a blood patch, where a small amount of the patient’s blood is injected into the puncture site to seal it.
  • Temporary Nerve Damage: The needle or catheter can sometimes irritate or damage nerves, causing temporary numbness, weakness, or pain. This usually resolves within a few days to weeks but can occasionally take longer.
  • Infection: There is a risk of infection at the site where the needle is inserted. This can range from a minor skin infection to a more serious infection that may require antibiotics or, in rare cases, surgical intervention.
  • Epidural Hematoma: This is a rare but serious complication where bleeding occurs in the epidural space, leading to pressure on the spinal cord. It requires urgent medical attention and sometimes surgical intervention to relieve the pressure.
  •  Urinary Retention: The epidural can affect the nerves that control the bladder, making it difficult to urinate. A catheter may be needed to help empty the bladder until sensation returns2.
  •  Itchy Skin: Some patients may experience itching due to the medications used in the epidural. This can be managed with medications to relieve the itching.
  • Catheter Migration: The catheter can sometimes move from its original position, which can reduce the effectiveness of the pain relief. This may require repositioning of the catheter.
  • Slow Breathing: Some medications used in epidurals can cause slow breathing or drowsiness. This is closely monitored and can be managed with medications if necessary.

It's important to discuss these potential complications with your healthcare provider to understand the risks and benefits of epidural anaesthesia for your specific situation. If you have any concerns or questions, don't hesitate to ask!