Epidurals and Epidural Anaesthesia: A guide for Patients
This page provides important information about epidurals. This is a type of injection of usually local anesthestic and strong painkiller just outside the fluid around the spinal cord, and usually a very narrow plastic tube (known as a catheter) is left in the epidural space to allow further injections or infusions of medications to be delivered. Epidurals are commonly used for pain relief during the final stages of pregnancy, in the hours leading up to delivery. They can also be used to provide excellent pain relief after certain surgical procedures involving the chest or abdomen.
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Depending on the medicines injected, the effect of an epidural ranges from complete lack of sensation and movement from the chest or abdomen downwards, to merely providing good pain relief after an operation.
The Process
This injection and catheter placement can be performed with you either awake, sedated or under general anaesthetic. For various reasons, the preference is normally for you to be awake. Your doctor will clean your skin with an antiseptic, and may press gently over your hips or shoulder blades to identify the correct location (in the centre of your back) at which to perform the injection.​
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Local anaesthetic may be injected into the skin around this area if you are awake. Your doctor will then pass a small needle into your back until they are satisfied they are in the correct location (the epidural space), and some fluid and medication here. The plastic catheter is now usually threaded into this space, and secured to your back with medical dressings. The effect of the injected medications will usually be assessed by checking your sensation to cold, often with a block of ice.
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Depending on the type, strength and amount of local anaesthetic injected (and how often this is repeated) and the addition of other medications (for example a strong painkiller), the effects of the epidural may last from several hours to multiple days. As the epidural wears off you may experience 'pins and needles' in the legs for a short time.
Risks
Almost all medical care and procedures carry some degree of risk of something not going according to plan, and it's important to be aware of this beforehand. Your anaesthetist is always best placed to provide information about the risks of anaesthesia specific to you and your upcoming surgery. The risks listed here are generic and not tailored to you and your circumstances. There are also multiple other less frequently encountered side effects/complications which are not listed here, to avoid providing an overwhelming list.
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1. Failure in the placement of the epidural. Often an epidural is easy to place, but sometimes it is technically challenging for a number of reasons
2. A patchy block can occur, where the epidural is affecting parts of your body as planned but not all the intended area
3. Nerve damage. Very rarely either temporary or permanent nerve damage to the spinal cord or nerves in the back can occur
4. Infection resulting from an epidural is rare but can be serious if it occurs
5. Bleeding resulting from an epidural is rare but can be serious if it occurs
6. Headache is rare but can occur if fluid that should be around the spinal cord leaks out. Sometimes a further injection in the back is required to treat this
7. Low blood pressure is may occur after an epidural, but is usually easily treated
8. Itching and shivering is common after an epidural has been placed, but is usually transient and not concerning
9. Loss of bladder control can occur, and usually resolves within hours. Sometimes a urinary catheter is required, however
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