Epidural anesthesia: use and administration

What is epidural anesthesia?

Epidural anesthesia is a type of anesthesia that is injected into the back, specifically in the epidural area (lower spine) and usually together with an anti-inflammatory (cortisone).

How is epidural anesthesia administered?

The anesthetic is injected through the skin of the back into the part of the spinal canal, previously creating a sterile field around and aseptizing the puncture area until reaching the so-called “epidural space”.

This procedure is performed by an anesthesiologist or a nurse anesthetist (CRNA).

How is pain blocked?

The spinal cord It is the main path for the pain signal. Nerves travel through the spinal cord to the brain, which perceives them as a painful stimulus.

What epidural anesthesia does is block nerves below the point where it is injected. For what it serves for reduce pain and tenderness in the lower half of the body while we are awake.

Risks and possible complications

• Drop in blood pressure (It can make the baby's heart rate drop temporarily).
• Headache and back for several days.
• Dizziness, seizures, breathing problems, allergic reaction to the anesthetic, nerve damage, or paralysis (all very rare).

Warning signs after anesthesia

• Signs of infection at the epidural injection site (redness, swelling, warmth or discharge from exudate ..).
• Fever over 38ºC.
• Shaking chills.
• Numbness or weakness in the legs that does not go away.
• Problems controlling your bladder.
• pain that is not relieved by regular pain relievers.

Epidural anesthesia during labor

Due to its characteristics, it is the anesthesia most used during labor. In addition, it can be used for labor and delivery itself.

When this type of anesthesia is applied, the woman feels a slight numbness of the legs and buttocks, but does not lose mobility. Being a local anesthesia, the woman can feel the contractions, but the pain is relieved.

In addition, if during the part it is necessary to use, perform one or vacuum extraction, it is not necessary to resort to another type of anesthesia.

Other advantages of an epidural during labor are:

• In case of not losing consciousness.
• By reducing blood pressure, it is a great option for women with toxemia or high blood pressure.
• It is also recommended to women with lung problemsas it decreases the work done by the lungs.
• Finally, for women with diabetes because it reduces the muscular activity of the legs, so they can better balance their insulin and glucose needs.

Can the epidural affect the baby in any way?

Studies conducted do not indicate no negative effect of the epidural on the baby.

It is also under study if the epidural is related to the initial difficulty that some babies have to latch onto their mothers' breast.

What has been shown is that epidurals have a minor impact than anesthesia that put you to sleep completely (systemic narcotics).

You should know that there are contraindications in some cases, although they are rare. So some women will have to resort to another type of anesthesia.

Epidural anesthesia in other types of surgery

• orthopedic surgery hip, knee or pelvic fractures.
• Herniorrhaphy (hernia repair).
• Urology as in prostatectomy or for the treatment of urolithiasis ("stones").
• Gynecological and obstetric surgery: cesarean section, hysterectomy (removal of the uterus by neoformative processes) or small surgeries in the pelvis.
• Vascular surgery such as limb amputation or revascularization of blood vessels in the legs.
• Pediatric surgery as in inguinal hernia.

• Due to its characteristics, it is the most used anesthesia in labor.
• The epidural blocks the nerves that enter the lower spine.
• The studies carried out do not indicate any negative effect of the epidural on the baby.

Alvaro Rebollo