What is an Epidural? Understanding Epidural Anesthesia for Pain Relief

An epidural is a type of injection administered in your back to effectively block pain signals from a specific area of your body. This procedure is known as epidural anesthesia and is frequently used to provide pain relief during childbirth, various surgical procedures, and even to manage chronic pain conditions.

When Are Epidurals Commonly Used?

Epidurals are versatile pain management tools utilized in a range of medical situations. Their primary applications include:

Labor and Childbirth: Epidurals are a popular and effective method for pain relief during labor, including both vaginal deliveries and Cesarean sections (C-sections). They allow mothers to remain comfortable and alert throughout the birthing process.
Surgical Procedures: Epidural anesthesia can be employed during certain types of surgeries. It can be used as the primary anesthetic or in conjunction with general anesthesia to manage post-operative pain. Surgeries in areas like the lower body, legs, or abdomen may benefit from epidural pain relief.
Post-Surgery Pain Management: Following major surgeries, especially those involving the chest, abdomen, or legs, epidurals can provide continuous and effective pain control. This helps patients recover more comfortably and facilitates earlier mobility.
Chronic Pain Conditions: In some cases, epidural steroid injections are used to treat chronic back and leg pain caused by conditions like sciatica or herniated discs (slipped discs). The steroid medication helps reduce inflammation around the spinal nerves, alleviating pain.

Preparing for Your Epidural Procedure

If you are scheduled to receive an epidural, it’s important to have an open conversation with your doctor or anesthesiologist. Discuss any concerns or questions you may have about the procedure, its benefits, and potential risks. Make sure to inform your healthcare provider about all medications you are currently taking, including prescription drugs, over-the-counter medications, and herbal supplements.

Your medical team will provide you with specific instructions regarding eating, drinking, and medication intake in the hours leading up to your epidural. It’s crucial to follow these instructions carefully.

It’s also important to plan ahead for your transportation home after the procedure. You will be advised not to drive for 24 hours following an epidural, as the medication can affect your reflexes and coordination. Arrange for someone to drive you home from the hospital or clinic.

How is an Epidural Administered? The Epidural Procedure Explained

Epidural administration is performed by a specialist doctor called an anesthesiologist. Here’s a step-by-step overview of what to expect during the procedure:

Preparation and Monitoring: You will typically be awake during the epidural procedure, although in certain surgical situations, it might be administered while you are under general anesthesia. An intravenous (IV) drip will be inserted into your arm to provide fluids throughout the procedure. Your vital signs, such as blood pressure and heart rate, will be monitored.
Positioning: You will be asked to either sit and lean forward, or lie on your side with your knees drawn up towards your chest. This positioning helps to curve your spine, making it easier to locate the correct insertion point.
Local Anesthesia: The anesthesiologist will clean the area on your back where the epidural will be inserted. A small injection of local anesthetic will then be administered to numb the skin. This will minimize any discomfort during the insertion of the epidural needle and catheter.
Catheter Insertion: A needle is carefully used to insert a thin, flexible plastic tube called an epidural catheter into the epidural space in your back. This space is located near the nerves that transmit pain signals to your brain. You may feel some pressure or mild discomfort as the needle is positioned and the catheter is inserted.
Needle Removal: Once the catheter is correctly placed, the needle is removed, leaving only the catheter in your back. The catheter is secured in place with tape on your back.
Medication Administration: Pain relief medication is then administered through the epidural catheter. These medications typically take about 20 to 30 minutes to achieve their full pain-relieving effect.

The epidural can be placed at different levels of the spine, depending on the area of the body requiring pain relief. While the medication is being administered, you may experience numbness in your chest, abdomen, and legs. Your legs might also feel weaker than usual.

The epidural catheter can remain in place to provide continuous pain relief. Medication can be administered manually or through an automatic pump. The duration of epidural pain relief can range from several hours during childbirth to a few days after major surgery.

For childbirth, “mobile epidurals” are sometimes used. These involve lower doses of pain medication, allowing women to walk around and move more freely during labor while still benefiting from pain relief.

Recovery After an Epidural

Once the epidural is discontinued, the numbness will gradually subside over a few hours. The effects of the epidural will wear off, and sensation will return to the affected areas.

As the medication wears off, it’s recommended to rest in a lying or sitting position until you regain full feeling and strength in your legs. This process can take a couple of hours, and you might experience a slight tingling sensation in your skin as feeling returns.

It’s important to inform your doctor or nurse if you experience any pain as the epidural wears off. They can provide you with appropriate pain medication to manage any discomfort.

Remember to avoid driving, operating heavy machinery, or consuming alcohol for 24 hours after receiving an epidural, as the medication can still affect your reactions and judgment.

Potential Risks and Side Effects of Epidurals

Epidurals are generally considered safe procedures, but like any medical intervention, they carry a small risk of side effects and potential complications. It’s important to be aware of these potential risks:

Low Blood Pressure (Hypotension): Epidurals can sometimes cause a drop in blood pressure, which can lead to feelings of lightheadedness, dizziness, or nausea. Your blood pressure will be closely monitored during and after the procedure to manage this risk.
Temporary Loss of Bladder Control: Epidural medication can temporarily affect bladder function, leading to difficulty urinating or loss of bladder control. This is usually temporary and resolves as the epidural wears off.
Itchy Skin (Pruritus): Some individuals may experience itching as a side effect of the opioid medications sometimes used in epidurals.
Nausea and Vomiting: Feeling sick to your stomach or vomiting can occur as a side effect of epidural anesthesia.
Headache: In a small percentage of cases, an epidural can cause a headache, known as a post-dural puncture headache. This type of headache is often positional and can be treated.
Nerve Damage: Nerve damage is a very rare but potential complication of epidurals. Serious long-term nerve damage is extremely uncommon.

Page last reviewed: 01 February 2023
Next review due: 01 February 2026