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  • What's an epidural?

    You have probably heard of epidurals already. They are in prolific use across the United States in essentially every hospital labor and delivery ward. Most people when they think about epidurals think it is a shot with a big needle in the back that takes pain away. Let’s learn a little bit more about them and their utility in other areas.

    An “epidural” typically refers to placement of a very small catheter in the epidural space and the continuous injection of local anesthetics and pain medications. The epidural space is a potential space, meaning typically there isn’t a space there, but with the proper technique it can be easily accessed and in a sense “created.”

    When an epidural is placed, the first step is a thorough pre-placement interview to ensure that there is no contraindication to its placements. Contraindications include but are not limited bleeding disorders, spinal hardware and types of pre-existing neuropathies. Also, your anesthesiologist will ask questions about your current and past health.

    The benefit of an epidural is it generally provides much better pain control than IV and oral pain medications. Local anesthetics numb the nerve roots directly that are transmitting pain signals, preventing their transmission. Also, it can be used to perform surgery without having to place someone under general anesthesia if needed. Rare risks are bleeding, infection, and nerve damage. More commonly the epidural can only work on one side or be completely ineffective. The primary risk is a risk of a severe headache. This is due to the epidural needle going slightly too far and puncturing the dural sac that contains the cerebrospinal fluid and spinal cord. The puncture causes CSF to leak out and the brain to sag due to the loss of fluid. This triggers a severe headache. This occurs approximately 1-3% of the time according to most studies. The headache can be either self-limiting or can be treated with another procedure known as an epidural blood patch.

    When placing an epidural, the patient either sits on the bed or lies on her side in a curled position. This aids with placement as it opens the space between the vertebral bodies. The back is cleaned and draped in a sterile manner. Local anesthetic is used to numb the skin at the site of entry. A larger needle is then slowly advanced. The anesthesiologist uses the feel of a syringe attached to the end of the needle to identify the epidural space. Once the epidural space is entered, there is a loss of resistance and the syringe is very easy to push, where it was once quite difficult to push. Then a small catheter is threaded in the epidural space. Medication is administered through the catheter to test whether the catheter has mistakenly entered the intrathecal space or the vasculature. If this test dose is negative, more medication is administered and the catheter is secured the back with tape and a sterile dressing. A pump is typically used to infuse local anesthetics and/or pain medication continuously.
    Epidurals can be used for the primary anesthetic for a variety of surgeries. They can also be used for post-operative pain control after major surgeries. Additionally, in those who suffer from certain types of chronic pain, medications can be injected into the epidural space in order to hopefully provide more long term pain treatment than oral or IV medications.

    James W. Stephens, DO
    Comments 1 Comment
    1. forumAdmin's Avatar
      forumAdmin -
      Well that just sounds AWFUL!
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