What is epidural anesthesia (epidural)?

Epidural Spinal Anesthesia - Animation by Dr. Cal Shipley, M.D. (February 2019).

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What is epidural anesthesia (epidural)?

Epidural Anesthesia (PDA) is a form of anesthetic anesthetic that causes relaxation and almost total pain relief throughout the abdomen. In epidural anesthesia painkillers are injected through a fine cannula in the back. This is called a regional anesthesia (colloquially often - not quite correct - local anesthesia), because the remedy is injected around the nerves that transmit the pain signals from the part of the body that feels pain during labor. Your stomach will become numb and you will not be in pain.

How does a PDA work?

First a local anesthetic is placed with a small cannula in order to insure the later puncture site. Then a hollow needle is inserted between the 3rd and 4th lumbar vertebrae until the tip lies in the epidural space. The epidural space or peridural space is located between the spinal cord and the vertebrae. Among other things, it contains the roots of the nerves emerging from the spinal cord, which are also responsible for the sensation of pain.

Next, place a small plastic tube over the needle into the epidural space and remove the needle. The tube is glued to the back and over the shoulder.

The anesthetist injects a local anesthetic (similar to the one you get from the dentist) into the tube to numb the abdomen. Your legs and feet will also be stunned. They no longer feel the contractions. Sometimes the hose is connected to a small pump to control how much local anesthetic has been given. Or the pump is prepared so that small doses of the anesthetic are added at certain intervals.

Epidural anesthesia or PDA is performed in several ways:

  • Injections at intervals : Your anesthetist injects a mixture of analgesics into the tube to numb the lower part of your abdomen. If epidural anesthesia works well, you should no longer feel your contractions. If the effect wears off, more narcotic drugs can be added. This can last for one to two hours.
  • Continuous Infusion : Your anesthetist sets an epidural catheter. The other end of the tube is connected to a pump that continuously pumps the analgesic solution into the back. You can also get a stronger dose if needed. Sometimes you can also control the pump.This is a patient-controlled epidural analgesia or PCEA, but only in some hospitals.
The benefit of low-dose epidural anesthesia is that you have a little feeling in your legs and feet, so it's also called mobile epidural anesthesia (or ""walking epidural""). If your maternity hospital has enough staff, you can even walk around with it. It is important to monitor whether you have enough leg feeling and that your blood pressure and heart rate are stable.

When should I have a PDA done?

You can have epidural anesthesia at any time during labor (NCCWCH 2007: 115). Most women opt for a PDA when contractions get very severe, which is often the case when the cervix is ​​only five to six centimeters open.

You are offered epidural anesthesia if your labor is to be accelerated with a syntocinone drip. This is a synthetic version of the hormone oxytocin, which expands the cervix and increases labor pains. You may need more painkillers because it can make contractions difficult to sustain (NCCWCH 2007: 238). If the cervix has already opened eight to nine centimeters, the midwife will tell you it's too late for a PDA, and you should try to get along without her until the impending birth.

Midwife Simone Uth: ""We recommend a PDA if birth does not progress, for example, because the woman is severely cramped and can not cope with labor or an unborn baby does not properly enter the birth canal. In a normal birth we would first try to work with the woman and encourage them to find a way to deal with the pain through breathing and exercise. Because: There is no possibility of freedom from pain without consequences! ""

In most cases, it means that the woman is lying in bed, several cables and the numbing of the legs severely restrict her freedom of movement, she needs a vacuum, since the It is often the case that women with PDA do not have the same amount of pressure and thus have more trouble pushing their child out from the outside without any intervention - in short, it is a good way to relieve the stress of complicated and lengthy births and has often prevented a caesarean section, but normal births can ""stall"" unnecessarily or be much more medical than necessary.

If you are receiving epidural anesthesia, the tube should remain in place until after your baby is born and the placenta is expelled. So you can also stay pain-free if you still need to be sewn after the birth of your baby (NCCWCH 2007: 121).

What are the benefits of epidural anesthesia?

It provides pain relief during labor (NCCWCH 2007: 113, Anim-Somuah et al 2005).

  • It's pretty fast. Preparations for a PDA take about 20 minutes and the effect occurs about 20 minutes after injection (OAA 2008a).
  • Additional doses may be given by an experienced midwife (NCCWCH 2007: 109). So you usually do not have to wait for an anesthesiologist when epidural anesthesia is initiated.
  • You stay fully conscious. You still feel your contractions, but you feel no pain.
  • If you have high blood pressure, the hypotensive effect is a useful side effect.
  • The birth process is progressing and you are probably more relaxed.
  • The method of PDA is sophisticated, and maybe your legs and feet will not be completely deaf.
  • There may be more regional anesthesia if you need a caesarean section.
  • What are the disadvantages of epidural anesthesia?

It may not work properly at first. You find that you are stunned only in some parts of your abdomen. If you are not painless half an hour after the onset of epidural anesthesia, ask your anesthesiologist to come back and stop everything or try again (NCCWCH 2007: 117).

  • You may shiver (RCOA 2006a).
  • Itching develops (NCCWCH 2007: 116; 128; Simmons et al 2007) or fever (OAA 2008a; NCCWCH 2007: 117).
  • You have to stay in bed. With low-dose epidural anesthesia, you may be able to move on the bed or even walk around. But this is only possible if the medical supervision is secured (there must be enough staff available, which is only the case in a few clinics).
  • You're probably getting a catheter to empty your bladder (MIDIRS 2008: 8; NCCWCH 2007: 197).
  • You must be more closely watched. The heartbeat of your child is constantly monitored. This will happen for at least 30 minutes after the first injection and after each new dose (NCCWCH 2007: 122). Your blood pressure will be measured every five minutes in the first half hour after epidural anesthesia and after each new dose (NCCWCH 2007: 117).
  • You may need an acceleration of labor due to a syntocinone drip (Anim-Somuah et al 2005, NCCWCH 2007: 110-12, 117). Hospital staff should give you the chance of a longer and slower delivery before using medication to speed it up (NCCWCH 2007: 150; 152-3).
  • The second stage of labor, the press phase, may take longer if you have epidural anesthesia (NCCWCH 2007: 113, Anim-Somuah et al 2005). If you do not feel the need to squeeze and your baby's head is not yet visible, you should wait at least an hour or until you feel the need to squeeze (NCCWCH 2007: 121).
  • The likelihood of having a pliers or sucking-fluff birth (NCCWCH 2007: 113, Anim-Somuah et al 2005) is increasing because epidural anesthesia can make it difficult for your baby to get into optimal birth position. When you are ready for birth, your baby may take a posterior occipital layer with the back of the head to your spine, even if it was not in that position when labor began (Lieberman et al 2005).
  • There is a small risk of a bad headache. This can happen if the needle injures the dura mater, allowing fluid to escape. The chance of this happening is 1: 100 (OAA 2008a). To remedy this, a small amount of blood is removed from the arm and then injected into the back to seal the hole caused by the needle. This happens after the birth of your baby. This procedure may need to be repeated more than once for the site to be truly sealed.
  • There is a very small risk of nerve damage that causes a numb spot on the leg or foot or a weak leg. This happens rarely. The risk of transient nerve damage is 1: 1,000 and that of permanent injury is 1: 13,000 (OAA 2008a).
  • How Does Epidural Anesthesia Affect My Baby?

It can cause your blood pressure to drop, which in turn affects your baby's oxygenation. A small tube, an intravenous cannula, must be inserted into your hand or arm if your blood pressure suddenly drops (NCCWCH 2007: 110; 115; Anim-Somuah et al 2005). Low blood pressure can be treated with electrolyte or saline solutions passed through the cannula. Your blood volume will be increased.

  • Epidural solutions contain opioids, fentanyl or similar medications that may come in contact with the placenta. In larger amounts (more than 100 micrograms), these agents may affect your baby's breathing or make him sleepy (NCCWCH 2007: 113).
  • Is there any useful advice?

Epidural anesthesia is performed only in hospitals (NCCWCH 2007: 113), not in birth houses or in home births.

  • Prepare that you can not get one. That depends on the offer of your local facility and the time when labor starts.
  • Keep still while the anesthetist sets the syringe. You will be lying on your side or bent over on the edge of the bed, so that the space between the vertebrae increases. Concentrate on your breathing, then it will be easier for you to hold still. Take a deep breath through your nose and slowly through your mouth. Hold the hand of your companion and try to stay in eye contact with him or her.
  • Not everyone can get epidural anesthesia (OAA 2008b: 9).Talk to your doctor to find out if your medical condition recommends a PDA.
  • If it's important for you to feel that your baby is born, then ask that the numbness dies down in the exhalation phase. If you feel the contractions, maybe you can press better. For some women, however, it is difficult to endure the pain. If you then stop the stunning in the final stages, this does not necessarily reduce the risk of pliers or pacifier birth to bring their baby into the world (Torvaldson et al 2004).
  • Sources

Anim-Somuah M, Smyth RMD, Howell CJ et al. 2005. Epidural versus non-epidural or no analgesia in labor.

Cochrane Database of Systematic Reviews Issue 4 www. mrw. inter science. wiley. com [accessed in May 2011] Ching-Chung L, Shuenn-Dhy C, Ling-Hong T et al. 2002. Postpartum urinary retention: assessment of contributing factors and long-term clinical impact.

Aust N Z J Obstet Gynaecol 42 (4): 365-8. Lieberman E, Davidson K, Lee-Parritz A et al. 2005. Changes in fetal position during labor and their association with epidural analgesia.

Obstetrics and Gynecology 105 (5 I): 974-82. Midir. 2008. Midwives Information and Resource Service. The use of epidural analgesia for women in labor.

MIDIRS Informed Choice - for professionals 6 Musselwhite KL, Faris P, Moore K et al. 2007. Use of epidural anesthesia and the risk of acute postpartum urinary retention.

Am J Obstet Gynecol 196 (5): 472. e1-5 NCCWCH. 2007. National Collaborating Center for Women's and Children's Health.

Intrapartum care: Care of healthy women and their babies during childbirth. Clinical Guideline. London: RCOG Press. www. nice. org. uk [called in May 2011] OAA. 2008a. Obstetric Anesthetists Association.

Epidural information card: Epidurals in labor - what you need to know. www. oaa-ANAES. ac. uk [accessed in May 2011] OAA. 2008b. Obstetric Anesthetists Association.

Pain relief in labor. www. oaa-ANAES. ac. uk [accessed in May 2011] RCOA. 2006a. The Royal College of Anesthetists.

Risks associated with your anesthetic. Section 3: Shivering. www. RCoA. ac. uk [accessed in May 2011] RCOA. 2006b. The Royal College of Anesthetists.

Risks associated with your anesthetic. Section 11: Nerve damage associated with spinal or epidural injection www. RCoA. ac. uk [accessed in May 2011] RCOA. 2008. The Royal College of Anesthetists.

Headache after an epidural or spinal anesthetic www. RCoA. ac. uk [accessed May 2011] Simmons SW, Cyna AM, Dennis AT et al. 2007. Combined spinal-epidural versus epidural analgesia in labor.

Cochrane Database of Systematic Reviews Issue 3. www. mrw. inter science. wiley. com [accessed May 2011] Torvaldsen S, Roberts CL, Bell JC et al 2004. Discontinuation of epidural analgesia late in labor for reducing the adverse outcome associated with epidural analgesia.

Cochrane Database of Systematic Reviews Issue 4. www. mrw. inter science. wiley. com [accessed May 2011] Wilson MJ, Macarthur C, Shennan A et al. 2009. Urinary containerization in high-dose vs mobile epidural analgesia: a randomized controlled trial.

Br J Anasth 102 (1): 97-103 Show sources Hide sources

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