Epidural anaesthesia

Overview

An epidural is an injection in the back to stop you feeling pain in part of your body.

This page covers epidural anaesthesia, a type of epidural commonly given for pain relief in childbirth and in some types of surgery.

When epidurals are used

Epidurals can be used:

during labour and childbirth, including caesareans
during some types of surgery
after some types of surgery

Steroid medicine can also be given with an epidural injection to treat pain in your back or leg that's caused by sciatica or a slipped (prolapsed) disc.

Preparing for an epidural

If you have any concerns or questions about having an epidural, discuss these with your doctor. Let them know about any medicines you're taking.

You may be given specific advice about eating, drinking and medicines before the epidural.

As you will not be able to drive for 24 hours after having an epidural, you'll need to arrange for someone to take you home.

How an epidural is given

Epidurals are given by a specialist doctor called an anaesthetist.

You're usually awake during an epidural, but for some types of surgery you may have it while under general anaesthetic.

A drip will be placed in your arm so you can be given fluids while you're having the epidural.
You'll be asked to sit down and lean forwards, or lie on your side with your knees up close to your chest.
You'll be given an injection of local anaesthetic to numb the skin where the epidural is to be inserted.
A needle is used to insert a fine plastic tube called an epidural catheter into your back (spine) near the nerves that carry pain messages to your brain.
The needle is then removed, leaving just the catheter in your spine.
You may feel mild discomfort when the epidural needle is positioned and the catheter is inserted.

The epidural can be inserted at different levels of your spine depending on the area of your body that needs pain relief.

Pain relief medicines are then given through the catheter. These take about 20 to 30 minutes to take full effect.

Your chest, tummy and legs may feel numb while the epidural medicines are being used, and your legs may not feel as strong as usual.

While the catheter remains in your back, it can be used to top up your pain relief drugs manually or using an automatic pump.

This can be for several hours (during childbirth) or for a few days (after major surgery).

Mobile epidurals, which use a lower dose of pain relief drugs, are sometimes used in childbirth, allowing you to walk around during labour.

Recovering from an epidural

When the epidural is stopped, the numbness usually lasts for a few hours before its effects begin to wear off.

While the medicine wears off, you'll probably be advised to rest in a lying or sitting position until the feeling in your legs returns.

This can take a couple of hours, and you may feel a slight tingling sensation in your skin.

Tell the doctor or nurse if you feel any pain. They can give you medicines to help control it.

Do not drive, operate machinery or drink alcohol for 24 hours after having an epidural.

Risks and side effects of an epidural

Epidurals are usually safe, but there's a small risk of side effects and complications, including:

low blood pressure, which can make you feel lightheaded or nauseous
temporary loss of bladder control
itchy skin
feeling sick
headaches
nerve damage

Side effects

Epidurals are usually safe, but as with all medical treatments, side effects and complications can sometimes happen.

Low blood pressure

It's normal for blood pressure to fall a little when you have an epidural. Sometimes this can make you feel sick.

Your blood pressure will be closely monitored. If necessary, fluids and medicine can be given through a drip to keep your blood pressure normal.

Loss of bladder control

After having an epidural, you may not be able to feel when your bladder is full because the epidural affects the surrounding nerves.

A catheter may be inserted into your bladder to allow urine to drain away. Your bladder control will return to normal as soon as the epidural wears off.

Itchy skin

This can be a side effect of the pain-relief medicines that may be used in your epidural.

Medicine can be given to help the itching, or the drug in the epidural can be changed.

Feeling sick

Feeling sick (nausea) is less common with epidural medicines than with other pain relief methods such as morphine and other opiates.

It can be treated with anti-sickness medicines, or by raising your blood pressure if it's low.

Inadequate pain relief

The epidural may not block all your pain. You may be offered an extra, or alternative, pain relief method.

Headache

A severe headache can happen if the bag of fluid that surrounds your spine is accidentally punctured. You may need specific treatment for the headache.

A procedure known as a blood patch may be used to seal up the puncture. It involves taking a small sample of your blood and injecting it into the puncture.

When the blood thickens (clots), the hole will be sealed and your headache will stop.

Not all headaches require a blood patch. Your anaesthetist will discuss your options with you.

Slow breathing

Occasionally, some medicines used in the epidural can cause slow breathing or drowsiness.

You will be monitored closely to look for this and it can be treated easily.

Temporary nerve damage

The needle or epidural tube can damage nerves, but this is uncommon. Nerve damage can cause loss of feeling or movement in parts of your lower body.

The most common symptom is a small, numb area with normal movement and strength. This usually gets better after a few days or weeks, but can sometimes take months.

Infection

An infection can sometimes happen around the skin next to the epidural tube.

It's rare for the infection to spread. Antibiotics may be necessary or, rarely, emergency surgery.

Permanent nerve damage

In rare cases, an epidural can lead to permanent loss of feeling or movement in, for example, 1 or both legs.

The causes are:

direct damage to the spinal cord from the epidural needle or catheter
infection deep in the epidural area or near the spinal cord
bleeding in the epidural area, causing pressure on the spinal cord
accidentally injecting the wrong medicines into the epidural catheter

These are rare events, and anaesthetists have extensive training to reduce the chances of these complications.

Nerve damage can also happen for other reasons during surgery, which are unrelated to the epidural.

Other complications

Other, very rare, complications of an epidural include:

fits (convulsions)
severe breathing difficulties
death

Before deciding to have an epidural, you should discuss the procedure with your anaesthetist.

They can provide further information and advice on the risks of developing complications.

The information on this page has been adapted by NHS Wales from original content supplied by

NHS website nhs.uk