Sarah Lewis, PharmD
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 for many surgeries and procedures. It is an important tool used to manage pain while you remain awake or lightly sedated. Your doctor also use epidural blocks with deep sedation and general anesthesia.
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Your spinal cord runs up and down through the spinal column in your back. The spinal column contains a stack of bones called vertebrae (backbones). 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. Discuss all your anesthesia options with your doctor to understand which option is right for you.
Why is an epidural block performed?
Your doctor may recommend an epidural block to block the pain of the following surgeries and procedures:
Abdominal surgery for postoperative pain control
Chest surgery for postoperative 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
Epidural blocks generally involve fewer side effects and complications than general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. An epidural block typically has a lower risk of complications of the 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. Epidural blocks also provide pain relief after major surgery when general anesthesia wears off.
Who performs an epidural block?
An anesthesiologist or nurse anesthetist performs an epidural block. 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.
How is an epidural block performed?
Your epidural block will be performed in a birthing center, hospital, or outpatient surgical setting.
Your spinal cord and spinal nerve roots are contained in a sac called the dural sac. The dural sac also contains spinal fluid. 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 fifteen minutes. The anesthetic medication takes effect within 10 to 20 minutes.
An epidural block generally includes these steps:
You will talk with a preoperative 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 understand and sign the surgical consent form.
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 care team will give you blankets for modesty and warmth.
You will talk with the anesthesiologist or nurse anesthetist about your medical history and the epidural block.
A surgical team member will start an intravenous (IV) line.
You may receive medication (a light sedative) to make you drowsy and relaxed, and possibly a pain medication.
You will lie on your side or sit upright with your back exposed.
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.
Your anesthesiologist or nurse anesthetist will use a larger needle to go through your skin and into your spine for the epidural injection.
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.
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.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may feel pinching or stinging as your anesthesiologist or nurse anesthetist injects the local anesthetic to numb your skin. You may also feel some pain and pressure during insertion of the larger spinal needle.
Tell our care team if any discomfort in your back does not pass quickly. You should not feel any pain after the epidural block takes effect. Tell your doctor if you begin to feel sensation during surgery or childbirth.
What are the risks and potential complications of an epidural block?
Complications of an epidural block are uncommon, but any procedure involves risks and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery. Risks and potential complications of an epidural block include:
Adverse reaction or problems related to sedation, anesthesia, or other medications, such as an allergic reaction and problems with breathing
Bleeding around the spinal column
Drop in blood pressure
Persistent leakage of spinal fluid
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my epidural block?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome.
You can prepare for an epidural block by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
In some cases, not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during general anesthesia, if used
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before an epidural block and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need an epidural block? Are there any other anesthetic options for me?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How do I take my medications?
How long with the epidural block last? How will you treat my pain after it wears off?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my epidural block?
Knowing what to expect after an epidural can help you get back to your everyday life as soon as possible.
How will I feel after the epidural block?
Your doctor may leave the epidural catheter (tube) in place after your surgery until you can take oral pain medications. You may feel numbness in your legs and have a tube in your bladder because you may not have the urge to urinate.
You will need to lie in bed until the feeling has completely returned to your legs and you can walk. You might feel a little drowsy from your sedative and pain medications. Tell your doctor or care team if your pain is not well controlled by your medication.
When can I go home?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You will go then home for an outpatient procedure or stay in the hospital for more care after a complex surgery.
You may still be a bit drowsy if you also had sedation or general anesthesia with your epidural block. You should not drive for about 24 hours and will need a ride home from your procedure. Someone should stay with you for the first day.
When should I call my doctor?
It is important to keep your follow-up appointments after an epidural Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
- Difficulty breathing
- Dizziness or fainting
- Loss of bladder or bowel control
- Pain that is not controlled by your pain medication
- Severe or persistent headache or back pain
- Skin rash, redness, swelling, or discharge at the catheter site
- Unexplained symptoms
- Weakness, numbness or tingling in your arms or legs
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- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf
- Regional Anesthesia and Analgesia for Surgery. American Society of Regional Anesthesia and Pain Medicine. http://www.asra.com/patient-info.php
- Spinal and Epidural Anesthesia. Aurora Health Care. http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2243847.html%22