Epidural Anesthesia During Labor

What is epidural anesthesia?

Epidural anesthesia is a regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.

Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic.

This produces pain relief with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure.

Benefits of epidural anesthesia in Labor?
  • Allows you to rest if your labor is prolonged.
  • By reducing the discomfort of childbirth, some women have a more positive birth experience.
  • Normally, an epidural will allow you to stay alerted and remain an active participant in your birth.
  • If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery.
  • When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
  • The use of epidural anesthesia during childbirth is continually being refined, and much of its success depends on the skill with which it is administered.

When will epidural be placed?

Typically epidurals are placed when the cervix is dilated to 4-5 centimeters and you are in true active labor.

How is an epidural given?

Intravenous (IV) fluids will be started before active labor begins and prior to the procedure of placing the epidural. You can expect to receive 1-2 liters of IV fluids throughout labor and delivery. An anesthesiologist (specialize in administering anesthesia), an obstetrician or nurse anesthetist will administer your epidural.

You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing the epidural effectiveness.

An antiseptic solution will be used to wipe the waistline area of your mid-back to minimize the chance of infection. A small area on your back will be injected with a local anesthetic to numb it. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back.

After that, a small tube or catheter is threaded through the needle into the epidural space. The needle is then carefully removed, leaving the catheter in place to provide medication either through periodic injections or by continuous infusion.The catheter is taped to the back to prevent it from slipping out.

Types of epidurals?

There are two basic epidurals in use today. 

Regular Epidural : After the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. A narcotic such as fentanyl or morphine is given to replace some of the higher doses of anesthetic, like bupivacaine, chloroprocaine, or lidocaine. This helps reduce some of the adverse effects of the anesthesia. 

Combined Spinal-Epidural (CSE) or “Walking Epidural” : An initial dose of narcotic, anesthetic or a combination of the two is injected beneath the outermost membrane covering the spinal cord, and inward of the epidural space. This is the intrathecal area. The anesthesiologist will pull the needle back into the epidural space, thread a catheter through the needle, then withdraw the needle and leave the catheter in place.

This allows more freedom to move while in the bed and greater ability to change positions with assistance. With the catheter in place, you can request an epidural at any time if the initial intrathecal injection is inadequate. You should ask about your hospital’s policy on moving around, eating and drinking after the epidural has been placed.

With the use of these drugs, muscle strength, balance, and reaction are reduced. CSE should provide pain relief for 4-8 hours.

When can an epidural NOT be used?
An epidural may not be an option to relieve pain during labor if any of the following apply:
  • When you use blood thinners
  • Yoy have low platelet counts
  • You are hemorrhaging or in shock
  • You have an infection on or in your back
  • You have a blood infection
  • If your cervix is not at least 4 cm dilated
  • If labor is moving too fast and there is not enough time to administer the drug
Information Source : americanpregnancy.org

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