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Information About Epidurals

What is an epidural?

 

 

Epidural anaesthesia is the term used to describe the blocking of nerve roots from the spinal cord with a local anaesthetic or painkilling drugs (opiates).

Epidurals are commonly used to:
  • relieve pain after major surgery on the chest, abdomen or lower limbs.
  • treat chronic back pain.
  • alleviate labour pains in pregnancy.

What are the benefits after major surgery?

Several studies have demonstrated that the quality of pain relief after surgery is best with an epidural. Epidurals also increase the blood flow in the veins of the legs, thus decreasing the chance of getting deep vein thrombosis (clot). If you have abdominal surgery, epidurals allow you to take deeper breaths and cough, thus decreasing your chance of getting a post-operative chest infection. Epidurals maintain intestinal function which means that you can eat and drink faster after surgery.

How does epidural anaesthesia work?

An epidural anaesthetic blocks the nerve roots that lead to the part of the body being operated on. These roots are located in a space near the spinal cord called the epidural space. This lies within the spine just outside the outer covering of the spinal cord.

How is an epidural given?

An epidural anaesthetic is always given by an anaesthetist. The anaesthetist locates the epidural space by inserting a thin hollow needle - usually into the lower part of the spine.
Some anaesthetists insert epidurals with the patient awake using local anaesthetic in the skin, and some insert them when the patient has already been put to sleep with a general anaesthetic.

A small plastic tube (catheter) is then introduced into the back through the needle and left in position when the needle is removed. This tube is usually connected to an automatic pump, which is adjusted to introduce a certain amount of local anaesthetic and painkilling medication into the epidural space every hour.

What are the side effects?

The most common side effects are:

  • A drop in blood pressure. This occurs in most cases and is usually easily treated with drugs or by giving fluids through a drip. For this reason, your blood pressure must be checked at frequent intervals throughout the procedure.
  • Itching. To maximise the pain relieving effect of the local anaesthetic, it is often mixed with an opiate drug. These opiate drugs can make the patient feel itchy.
  • Inability to move the legs. The local anaesthetic may block the nerves supplying the muscles of the legs as well as those nerves carrying pain signals. This means that you may not be able to move your legs or get out off bed whilst the epidural is in use.

Rare, but important side effects are:

  • Headache (also known as a spinal headache). This happens to 1 in 100 patients who have an epidural and is due to the needle passing into the spinal space. It can be treated successfully by an anaesthetist. This type of headache can be severe and last more than 24 hours, requiring total rest and strong pain killers.
  • Infection around the spinal cord (abscess or meningitis). This happens to 1 in 50000 patients.
  • Damage to nerve tissue. This can be caused by a blood clot pressing on the nerves or direct trauma by the needle. It happens to 1 in 10000 patients.

Can all patients have an epidural?

Epidural anaesthesia has been used for many years, and is a safe and reliable technique. You will receive full information so you can decide if want to go ahead with the procedure.

There are certain conditions where epidural anaesthesia cannot be given such as infections, a tendency to bleed and nervous system diseases.


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