Epidural Block

What is an epidural block?

An epidural block is a type of regional anesthesia that blocks pain sensation in the legs, abdomen or chest. An epidural block involves injecting a local anesthetic near certain spinal nerves to numb a specific area of your body. Doctors use epidural blocks in a wide variety of surgical and other procedures. It is an important tool used to manage pain while you remain awake or lightly sedated. Your doctor may also use an epidural block with deep sedation or general anesthesia.

Your spinal cord runs up and down through the spinal column in your back. The spinal column contains a stack of bones called vertebrae (back bones). Nerves branch off your spinal cord through the spaces between the vertebrae and run out to all areas of your body. These nerves bring pain sensations back to your spinal cord, where they travel to the brain. An epidural block stops pain sensations from reaching the brain so you do not feel them.  

An epidural block is only one method used to provide regional anesthesia.You should discuss different anesthesia options with your doctor or healthcare provider to best understand which option is right for you. 

Why is an epidural block performed?

An epidural blockis a form of regional anesthesia that your doctor may use to block pain sensations during or after certain types of surgeries, such as:

• Abdominal surgery for post-operative pain control
• After chest surgery for post-operative pain control
• Cesarean section
• Gastrointestinal surgery of the stomach, liver or intestines
• Gynecologic surgery such as a hysterectomy
• Labor and vaginal delivery
• Orthopedic surgery of the legs or feet
• Pelvic or hip surgery
• Urologic surgery of the prostate, kidney or bladder
• Vascular surgery, such as lower extremity graft bypass

Doctors frequently choose epidural blocks because it involves fewer side effects and complications than general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a special type of sleep. An epidural block typically has a lower risk of complications to your heart and lungs.

An epidural block is particularly useful for labor and delivery, including cesarean sections. This is because it allows the mother to remain awake but free of pain. In some cases, an epidural block can provide pain relief after major surgery following general anesthesia.

How is an epidural block performed?        

An anesthesiologist or nurse anesthetist will perform your epidural block in a birthing center, hospital, or outpatient surgical setting. An anesthesiologist is a doctor who specializes in providing anesthesia and pain relief. A nurse anesthetist (Certified Registered Nurse Anesthetist, CRNA) is a registered nurse with advanced training and education in anesthesiology.

Your spinal cord and spinal nerve roots are contained in a sac called the dural sac. The dural sac also contains spinal fluid. For an epidural block, your doctor will insert a needle and inject anesthetic in the area just outside the dural sac. This differs from a spinal block in which your doctor advances the needle through the dural sac into the spinal fluid. The epidural block procedure takes about ten to fifteen minutes. The anesthetic medication will take effect within 10 to 20 minutes. An epidural block generally includes these steps:

1. You will talk with a pre-operative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you sign the surgical consent.
2. You will remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your surgical team will respect your privacy and give you blankets for modesty and warmth in the surgical suite.
3. You will talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
4. A surgical team member will start an intravenous (IV) line.
5. You may receive medication (a light sedative) to make you drowsy and relaxed, and possibly a pain medication.
6. You will lie on your side or sit upright with your back exposed.
7. Your anesthesiologist or nurse anesthetist will clean the injection area of your spine. He or she will inject a small amount of local anesthetic into your skin to numb it.
8. Your anesthesiologist or nurse anesthetist will use a larger needle to go through your skin and into your spine for the epidural injection.
9. For long-lasting anesthesia, a thin catheter placed in your spine provides continuous medication. This catheter also stays in place if you need continued anesthesia after surgery.
10. The surgical team will monitor your vital signs and other critical body functions. This occurs throughout your surgery and recovery until you are alert, breathing effectively, and your vital signs are stable. You may have a catheter (tube) inserted into your bladder to collect urine.