What is an epidural?
An epidural is an injection of local anaesthetic in the lower back into a space where nerves supplying the legs, uterus and abdomen run. This causes numbness to the part of your body experiencing contractions (for labour) and/or the part being operated on. A tiny catheter (tubing) is fed into this space to allow controlled pain relief for up to 4 days.
Why should I have an epidural?
Better pain control: an epidural is the best form of pain relief available for labour contractions and pain associated with surgery. When working well (>95%), patients experience a sensation of ‘pressure’ without any pain.
Less side effects: you will have less chance of being itchy, nauseated, sleepy or having trouble going to the bathroom.
Anaesthesia for surgery: a stronger local anaesthetic can be administered through the epidural catheter to provide anaesthesia for surgery of the abdomen, pelvis and/or lower limbs. This avoids the need for general anaesthesia. For example, an epidural used for labour, can also be safely used to provide anaesthesia for a caesarean section, if required
How is an epidural done?
I position you sitting up over the side of your bed with your back flexed. I clean your skin, and inject local anaesthetic to numb the skin around the epidural area. While you keep still, and using a special needle, I place the catheter in the epidural space. I administer several doses of the local anaesthetic to safely achieve pain relief. This usually takes 10-20 minutes for full effect.
The catheter remains in place for the duration of your labour and/or surgery, and its effects last for several hours after the catheter is removed. It is important to let me know if anything bothers you while the epidural is placed.
Will the epidural work?
Epidural blocks work very well. They have a high success rate (>90%). I always test your epidural and ensure you are satisfied. If it is not working well, another epidural may be performed or we may decide to give you another form of pain relief. Either way, I will ensure you are safe and comfortable.
Are there any side effects or complications from epidurals?
The side effects include: a decrease in blood pressure (which is easily treated with medications); weakness of the legs which means you will have to remain in bed during its use; inability to use your bladder which will necessitate a urinary catheter; shivering; and itchiness.
Complications can be classified as follows:
Minor: 1% risk of dural puncture headache, which may necessitate another procedure to treat this.
Major: Extremely rare but serious risks which occur < 1:50,000 cases.
‘Spinal block’ which may cause a loss in consciousness, drop in blood pressure and the need for a ventilator to assist with breathing.
Permanent nerve damage due to abscess (infection) or haematoma (collection of blood).