Diseases & Conditions

AN Epidural - Epidural Anesthesia


Overview & Description

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

Who is a candidate for the procedure?

An epidural, as the procedure is commonly called, is usually used for procedures performed below the rib cage. It is often the preferred way to reduce pain during childbirth. It can also be used for pain control after surgery or childbirth. Sometimes an epidural is used instead of general anesthesia if a person is very weak or sick.

How is the procedure performed?

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

An epidural is different from spinal anesthesia, a procedure in which the medication is injected inside the sac that contains the spinal cord. Epidurals are usually preferred for childbirth and are often better for pain control. Spinals require less medication and work faster, but they are more likely to cause headaches and low blood pressure.

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

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

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


Preparation & Expectations

What happens right after the procedure?

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

The numbness and paralysis usually go away within a few hours. The individual is asked to lie flat on his or her back for an hour or more after the procedure. 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 some cases, the person is able to go home later the same day. If sedatives were used, someone must drive the person home. After childbirth, a woman usually stays in the hospital at least overnight.


Home Care and Complications

What happens later at home?

A bandage is usually placed over the area on the back where the needle or tube was inserted. The bandage should be left on for at least 24 hours and the area should be undisturbed. Usually no other care is needed at home for the epidural anesthesia, 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 occurs in roughly 1 out of every 10,000 people who have epidural anesthesia. It is not possible 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 often responds to pain medication. Sometimes another injection in the back is needed to help the pain. Nausea is also fairly common in the first few hours after the procedure.

Blood pressure can drop very low during an epidural, but this usually doesn't cause problems. Allergic reactions, arrhythmias or irregular heartbeats, and seizures are rare complications of an epidural. Bleeding and infection can occur at the site of the needle injection. Other side effects may occur, depending on the medications used.

The American Society of Anesthesiologists recently issued a warning about the potential 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 least two weeks before planned surgery.


Attribution

Author:Adam Brochert, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:11/29/00
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:07/05/01

Sources

Textbook of Surgery, 1997, Sabiston et al.

Anesthesia, 1990, Miller et al.