Epidural Anesthesia: Uses, Procedure & Risks

Epidural anesthesia is a type of regional anesthesia that blocks pain in a specific area of the body, usually from the waist down. This may include the abdomen, pelvis, back, and legs.

Epidural anesthesia may be used for procedures such as C-sections, gynecologic surgery, and some other operations. It can allow a person to remain awake during surgery because it usually does not affect consciousness.

Epidural anesthesia is administered in a hospital by an anesthesia professional. An anesthetic medication is delivered into the epidural space near the spinal nerves to temporarily block pain signals.

How it works

Epidural anesthesia may be used to block pain during certain abdominal, pelvic, leg, or chest surgeries.

Epidural analgesia may also be used to manage pain during and after surgery, with medication delivered continuously or intermittently through an epidural catheter.

Common uses

Epidural anesthesia may be recommended for procedures such as:

• C-sections

• General surgical procedures involving the breast, stomach, or liver

• Orthopedic procedures involving the hip or knee, as well as some pelvic fractures

• Gynecologic procedures, such as hysterectomy or minor pelvic floor surgery

• Urologic procedures, such as prostate surgery or kidney stone removal

• Vascular procedures, such as amputation or procedures to restore blood flow in the legs

• Pediatric procedures, such as inguinal hernia repair or orthopedic surgery

Epidural analgesia is commonly used during vaginal delivery to relieve labor pain. Pain-relieving medication is given through an epidural catheter and can be adjusted as needed throughout labor.

How to prepare

Before epidural anesthesia, the healthcare team will provide instructions about when to stop eating and drinking. These instructions may vary depending on the procedure and the type of anesthesia or sedation being used.

Tell the healthcare provider about any allergies and all medications and supplements being used. This is especially important for blood thinners, as some may need to be temporarily stopped or adjusted before the procedure.

Blood-thinning medications should not be stopped unless instructed by the healthcare provider who manages them.

If you will be going home the same day, arrange for someone to drive you. Driving is generally avoided for at least 24 hours after epidural anesthesia or for as long as the healthcare team recommends.

How it's performed

Epidural anesthesia is performed in a hospital or surgical setting, usually using an epidural catheter. An IV line is generally placed beforehand so fluids and medications can be given if needed, including treatment for a drop in blood pressure.

To administer epidural anesthesia, the anesthesia professional generally:

• Positions the person sitting and leaning forward or lying on their side with the knees bent
• Cleans the skin to reduce the risk of infection
• Identifies the appropriate space between the vertebrae
• Injects a local anesthetic into the skin to reduce discomfort
• Inserts a needle into the epidural space and passes a thin plastic tube, called a catheter, through it
• Removes the needle, leaving the catheter in place
• Administers the anesthetic medication through the catheter

The procedure is not usually very painful, although a brief sting may be felt when the local anesthetic is injected. Pressure or mild discomfort may also occur during placement.

According to the American College of Obstetricians and Gynecologists (ACOG), pain relief from an epidural typically begins within 10 to 20 minutes after the medication is started.

The amount of medication and how long it is given can be adjusted as needed. In some cases, an epidural may be combined with spinal anesthesia for a faster effect.

Sedation may also be given through an IV to help the person relax or become drowsy.

Potential risks

Epidural anesthesia is generally considered safe, but side effects and complications can occur. According to the American Society of Anesthesiologists (ASA), serious complications are extremely rare.

Possible side effects include low blood pressure, headache, chills, shivering, nausea, vomiting, infection, nerve damage, or bleeding in the epidural space.

A headache can also occur if the epidural needle accidentally punctures the membrane surrounding the spinal cord, allowing cerebrospinal fluid (CSF) to leak. This is known as a post-dural puncture headache.

Aftercare instructions

After the epidural is stopped, numbness may continue for a few hours before gradually wearing off. It is important to remain lying down or seated as instructed until normal strength and sensation return to the legs.

If pain occurs, tell the healthcare team so appropriate pain medication can be given.

Do not drive for at least 24 hours after epidural anesthesia or until the healthcare team confirms that it is safe. Alcohol should also generally be avoided for at least 24 hours after anesthesia, especially if sedating medications were used.

Epidural vs spinal anesthesia

Epidural anesthesia differs from spinal anesthesia mainly in where the medication is given and how it is administered:

• Epidural: The medication is delivered into the epidural space outside the membranes surrounding the spinal cord. A catheter is usually left in place so medication can be given continuously or in repeated doses. The amount of medication can be adjusted as needed.
• Spinal: A needle passes through the dura, and a smaller amount of medication is injected directly into the cerebrospinal fluid. It is usually given as a single injection and produces rapid numbness, often with temporary muscle weakness below the level of the injection.

Epidurals are commonly used during labor because the catheter allows additional medication to be given over several hours. Spinal anesthesia is commonly used for procedures that require a rapid and predictable anesthetic effect, including many C-sections.

When complete unconsciousness is needed or regional anesthesia is not appropriate, general anesthesia may be used.

Contraindications for use

Epidural anesthesia is generally safe, but it may not be appropriate for everyone.

It may be contraindicated in people with an infection at or near the injection site, certain serious infections, severe blood-clotting problems, or use of some anticoagulant medications.

Certain causes of increased intracranial pressure may also make epidural anesthesia unsafe.

Spinal abnormalities or previous spinal surgery can make placement more difficult but do not always prevent an epidural.

An epidural may also not be possible if the epidural space cannot be safely accessed.