Epidural

Overview

An epidural involves injecting medication, such as an anesthetic or steroid, into the epidural space around the spinal nerves. This procedure is designed to provide pain relief (analgesia) or complete numbness (anesthesia) in a specific area of the body, like the legs or abdomen.

An epidural is also commonly referred to as:

• Epidural block
• Epidural anesthesia
• Neuraxial anesthesia
• Epidural Steroid Injection (ESI)
• Regional anesthesia

The epidural anesthesia injection works by delivering an anesthetic into the epidural space surrounding the spine. This effectively blocks pain signals from reaching the brain. The epidural space, which is filled with fluid, acts as a protective liquid sleeve around the spinal cord.

Kinds of epidurals

There are various types of epidurals, each tailored to specific factors. This section will describe the different kinds of epidurals, categorized as follows:

• Epidurals for labor and delivery.
• Epidural Steroid Injection (ESI).
• The method used to administer the drug.
• Delivery options for epidural medications

Using an epidural, your doctor can provide medication in a number different methods, such as:

• Single-injection epidural: This type of epidural involves a single injection of medication—either an anesthetic or a steroid—into the epidural space around your spine. After receiving a single anesthesia epidural injection, sensation in the affected area usually returns within a few hours. This method offers short-term pain relief. Most epidural steroid injections are given as single injections.
• Epidural with a catheter: Most epidural procedures involve the use of a catheter placed in the epidural space, which allows your doctor to deliver a continuous flow of anesthetic medication, multiple separate doses, or both. A catheter is a small, flexible tube inserted through a narrow opening into a body cavity. In this case, the catheter is positioned to open into the epidural space around your spine. This setup enables your doctor to provide more than one injection of medication. This type of epidural is commonly recommended for longer surgeries, extended pain relief over several days, and for labor and childbirth.
• Epidural with Patient-Pontrolled Analgesia (PCA): After certain types of surgery, your doctor might allow you to manage your own pain relief using an epidural catheter through a method known as Patient-Controlled Analgesia (PCA). The PCA pump is set up with controls tailored to your age, weight, and the specific surgery performed to deliver the prescribed pain medication. This pump is designed to be safe, allowing you to administer medication by pressing a button when you experience pain, but it prevents delivering another dose if it’s too soon.

Labor and delivery epidurals

You can select between two common types of epidurals for use during labor and delivery. Among them are:

• Epidural with a catheter: Your doctor will deliver medication through a catheter inserted into your lower back via an epidural injection. The catheter stays in the epidural space, allowing your doctor to administer additional medication as necessary.
• Combined Spinal-Epidural (CSE): A CSE involves two injections: a spinal injection (spinal block) and an epidural. This method offers quicker pain relief compared to an epidural alone. Since it uses a lower dose of medication, you retain some sensation in your lower body, making it easier to move and change positions. Often referred to as a “walking” epidural, most people are not able to walk fully with this type of epidural.

Epidural Steroid Injections (ESI) involve injecting a steroid or corticosteroid into the epidural space around your spine. This procedure can relieve pain in the neck, arms, back, and legs caused by inflamed spinal nerves due to various conditions or injuries. The relief from an ESI can last anywhere from several days to several years.

Epidural steroid injections may be beneficial for those experiencing discomfort in the neck, arm, lower back, or leg as a result of the following conditions:

• Sciatica.
• Spinal stenosis.
• Spondylolisthesis.
• Herniated disk (slipped, ruptured or bulging disk).
• Degenerative disk disease.

Reasons for undergoing the procedure

Your spinal cord serves as a pathway connecting nerves throughout your body to your brain. When injured, nerves in specific body areas send pain signals through the spinal cord to the brain and back. An epidural anesthetic temporarily numbs these spinal nerves, blocking pain signals in a specific region of your body based on where the injection is placed along your spine.

Epidural anesthesia can offer temporary pain relief or complete numbness. The extent of temporary numbness from an epidural depends on the following factors:

• The kind of anesthetic medication your doctor prescribes.
• The drug’s concentration, or how strong it is.
• The medication’s dose.

An Epidural Steroid Injection (ESI) functions differently and is typically used to manage chronic pain. Instead of using anesthetic medication, your doctor injects a steroid or corticosteroid into the epidural space surrounding your spine. Rather than blocking pain or sensation in a specific area, the steroid coats the inflamed nerve(s) responsible for your pain and reduces swelling. This allows the nerve(s) to heal over time. Epidural steroid injections can result in temporary, long-term, or even permanent relief from pain.

Your doctor may recommend an epidural procedure for the following conditions:

• To ease pain following specific surgical procedures.
• To offer analgesia, or pain treatment, during labor and delivery.
• To administer anesthesia in place of general anesthesia during specific procedures.
• To treat specific types of chronic pain, including back pain (with epidural steroid injections).

Risks

Although epidurals are generally safe, there is a chance of some problems and negative effects. All forms of epidural procedures carry some risks and problems, albeit they are uncommon. These include:

• Having a really bad headache as a result of spinal fluid leaks. It is less than 1% of the population that has this adverse effect.
• Developing an infection following the epidural procedure, such as meningitis, osteomyelitis, discitis, or epidural abscess.
• Experiencing side effects from the drugs, such rash or hot flushes.
• Temporarily becoming unable to control your bowels and bladder. To assist you urinate, you might require a catheter—a tiny tube—in your bladder.
• Experiencing hypotension, which may cause dizziness.
• Bleeding in the event that an injection unintentionally damages a blood vessel, which could result in the formation of a hematoma or blood clot.
• Experiencing nerve injury where the injection was made.

Particular drawbacks and hazards associated with epidural analgesia during childbirth include:

• It could delay down the second stage of labor.
• You might not be able to push and require assistance to give birth
• You might lose feeling in your legs for a few hours. For the delivery of your baby, your healthcare practitioner might need to utilize a vacuum or forceps.
• Throughout your labor, your baby will need to be closely observed.

Particular risks and issues associated with epidural steroid injections are as follows:

• Feeling a brief increase in pain.
• There will be very little low-level radiation exposure because of the X-rays if your doctor uses a Computed Tomography (CT) scan or fluoroscopy for imaging guidance.
• A steroid injection is likely to result in hyperglycemia, or elevated blood sugar, if you have diabetes. This can continue for a few hours or perhaps a few days.

Before the procedure

You will receive detailed instructions from your doctor regarding how to get ready for your epidural. Make sure you adhere to their guidelines. Your supplier could possibly:

• Have you skipped meals and liquids for a predetermined period of time before to receiving an epidural.
• Modify the dosage of some of your medications, particularly the blood thinners.
• After your epidural, make sure you have a rider to take you home.

Before receiving an epidural, you might find it useful to ask your doctor the following questions:

• What frequency do you administer epidurals?
• What dangers come with receiving an epidural?
• How much time will it take for my epidural to wear off?
• How should I get ready for my epidural?
• What’s the duration of my epidural?
• How is my epidural going to feel?

During the procedure

This section will cover the general process for two types of epidurals: catheter-based and epidural steroid injections.

The procedure for single-injection epidurals is similar to that of catheter-based epidurals, except that no catheter is used. Instead, when your doctor inserts the needle into the epidural area, they will administer a single dose of medication.

Epidural with a catheter procedure

When performing an epidural procedure with a catheter, the following stages are involved:

• Your doctor will probably place a cannula into a vein in your arm prior to your epidural treatment so that, should the need arise, a medical drip can be connected to it. This is a safety measure in the event that the epidural causes your blood pressure to plummet. In the event that this occurs, your doctor can rapidly access the cannula to administer medicine to assist lower your blood pressure.
• In order to make it easier for your doctor to view and reach the place where the epidural will be inserted, you will probably need to sit up or lie on your side. In either case, you should tuck your chin into your chest and arch your back.
• To reduce the chance of infection, your doctor will meticulously clean the region of your back where the epidural will be inserted.
• Next, a tiny needle will be used to inject local anesthetic in the vicinity of the epidural site. This is so that, while the epidural needle is larger than a regular shot needle, like a vaccine shot needle, you won’t experience as much agony during its insertion.
• After that, your doctor will place the epidural needle in your back, right outside the spinal cord. Your lower back will be the site of an epidural if you’re receiving one during labor and delivery.
• After that, they will insert a catheter—a tiny, pliable tube—through the needle and into the area of your back where it entered.
• The catheter will stay in your back, and they will remove the epidural needle.
• As long as necessary, your doctor can now administer anesthetic medication to you through the catheter.
• When the epidural is no longer necessary, your doctor will take out the catheter, give the area another antiseptic cleaning, and cover the site with a dressing.

Epidural steroid injection procedure

Epidural steroid injections are commonly employed for managing chronic pain. Depending on the source of your pain, your doctor will administer the injection at a specific location along your spine. Here are the typical steps involved in an epidural steroid injection procedure:

• To reduce the chance of infection, your doctor will thoroughly clean the region of your back where the epidural will be inserted while you lie on a comfortable table on your side or stomach.
• A tiny needle will be used by your doctor to inject local anesthetic in the vicinity of the epidural site. This is so that when the larger-than-normal epidural needle is inserted, you won’t experience as much agony.
• After the area has become numb, your doctor will probably use an imaging device—a CT scanner or fluoroscopy machine, for example—to help precisely insert the epidural needle.
• Your doctor will inject the contrast material once the epidural needle has been inserted into the epidural area surrounding your spinal cord. Your doctor will be able to view the targeted area on the imaging machine’s screen more easily thanks to the contrast material. This makes it more likely that the drug will get to the irritated nerves it is intended to treat.
• After that, your doctor will gradually inject the drug, which is typically an anti-inflammatory drug like a steroid or corticosteroid. Some doctors might inject a combination of long-acting anesthesia and corticosteroid.
• After administering the injection, your doctor will clean the region once again and dress the wound. You’ll spend a few minutes to an hour resting in a chair or bed. This is so that, before you go home, your doctor can make sure you are not experiencing any drug responses.

During your epidural procedure, you will experience:

• When your doctor administers the local anesthetic to numb the area prior to the epidural operation, you probably feel a slight pinch.
• During the epidural injection, you can experience pressure, tingling, burning, or a brief shooting pain. Or perhaps you have no feelings at all. Any soreness you experience during the injection normally goes away after it’s done.

Inform your doctor right away if you have severe, sharp pain during or after your epidural surgery.

After the procedure

If you’ve received an epidural with anesthetic medication, it typically takes 20 to 30 minutes for the full effect of pain relief and/or numbness to be felt.

Epidural steroid injections typically begin to take effect within two to seven days, providing pain relief that can last for several days or even longer.

Outcome

The duration of effectiveness of an epidural varies based on the type administered and the medication used by your doctor. Your doctor will inform you about the expected duration. Generally, here is the typical duration of various types of epidurals:

• Epidural with a catheter: If you receive an epidural with a catheter, your doctor can provide a continuous stream of anesthetic medication or multiple separate doses, customized to your condition and pain level. After the medication is stopped, you may experience numbness for several hours as its effects gradually wear off. During this period, you may need to stay lying down or sitting until sensation fully returns to your legs. You might also feel a slight tingling sensation as you recover.
• Single-injection epidural: Single injection epidurals typically provide several hours of numbness before sensation begins to return to the affected area.
• Epidural steroid injection: The duration of pain relief from an epidural steroid injection varies widely. Individuals with a new disk herniation may experience permanent pain relief. For those managing chronic pain, epidural steroid injections typically offer relief lasting from 3 to 6 months or longer.

After receiving an epidural, avoid driving, operating machinery, or drinking alcohol for at least 24 hours. Your doctor will give you specific instructions on when you can return to your usual activities, based on the type of epidural you had and your individual situation. It’s crucial to follow these guidelines closely.