Patient Information Sheet - Epidural

24th December 2006 at 18:46 GMT by Dr C.A.Jenner MB BS, FRCA. Permalink.

Patient Information Sheet on Epidural for the treatment of painful spine conditions

Patient Information Sheet - Epidural

What is an Epidural?

An epidural is a form of a regional anesthesia involving injection of drugs through a catheter placed in to the epidural space. The injection leads to a loss of sensation (anesthesia) and a loss of pain (analgesia), in accordance with the medication administered.

The epidural space is a part of the human spine inside the spinal canal separated from the spinal cord and its surrounding cerebrospinal fluid by the dura mater.

Today, epidurals are widely accepted as an integral part of the non-surgical management of lower back pain. While the effects might be temporary, ranging from one week upto one year, an epidural can be very beneficial for patients suffering from an episode of severe back pain.

What is an Epidural used for?

Pain relief is the most important purpose for which an epidural might be administered.

Here we list some of the most important and common uses of an epidural:

1. For pain relief, when surgery is not contemplated.
2. As an adjunct to general anesthesia. The anesthetist may use epidural analgesia in addition to general anesthesia.
3. For temporary pain relief, to facilitate rehabilitation.
4. As the only technique for surgical anesthesia. A Caesarean section for childbirth is the most common example in this category.
5. For post-operative pain relief, analgesics might be given in the epidural space for a few days after the surgery, in cases where a catheter has been inserted.
6. For relief from back pain. This is normally done with an injection of analgesics and steroids into the epidural space.
7. For the treatment of chronic pain or palliation of symptoms in terminal care, usually for short or medium term.

The most common local anesthetics used for the above listed purposes include:

• Lidocaine
• Bupivicaine
• Ropivicaine
• Chloroprocaine

Research shows that an epidural is most useful for analgesia for the abdomen, pelvis or legs as compared to the analgesia for the chest, neck or arms.

When a catheter is placed into the epidural space, the effects of the analgesia may be prolonged for several days, if required.

What is the procedure?

An epidural should be administered only by specialists, qualified and trained to do the procedure, such as an anesthesiologist, radiologist, neurologist, physiatrist and surgeon.

The entire procedure takes between 15 and 30 minutes. Here we list the main steps involved:

1. The patient lies flat on an x-ray table on the abdomen.
2. Before the injection is administered, the skin is numbed with lidocaine.
3. Using fluoroscopy.i.e. live x-ray for guidance, the physician directs a needle toward the epidural space.
4. Once the needle is in the exact position, the epidural solution is injected.
5. The patient is then kept under observation for 15 to 20 minutes.

.

What are the risk factors?

Thought quite infrequent, but this procedure also has certain potential risks and side effects, including:

• Infection
• Bleeding
• Nerve damage
• Dural puncture
• High blood sugar
• Stomach ulcers