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 p