Scared about an epidural? Let's talk about it all in simple terms!

Has your doctor ever told you about an epidural? Maybe it was for childbirth, or surgery, or back pain. It's normal to feel a little nervous and hesitant about getting an injection close to your spine. But what is it really? Is it safe? What does it do? Don't worry, we'll talk about it simply, in a way that you can understand.

Simply put, what is an epidural?

An epidural is an injection of a painkiller into the empty space around the nerves in your spine. We call this space the 'epidural space'. That's how the name came about.

Think of our spine as a tube with lots of wires running through it. Inside this tube is the spinal cord. Outside this tube, that is, the empty space inside the spine, is called the epidural space. By injecting painkillers into this space, they temporarily stop the pain signals that travel through those nerves to the brain.

Doctors use epidurals in a variety of situations. For example:

• Control pain during childbirth .
• Before surgery, induce anesthesia .
• Relieve pain after surgery .
• Treat back pain caused by conditions such as a herniated disc.
• Manage chronic pain .

There are two main types of epidurals:

Depending on the reason we give an epidural, there are two main types. To understand this clearly, see the table below.

How does this work? Methods of giving an epidural

The way an epidural works varies depending on the type.

• An epidural anesthesia temporarily blocks the signals from the pain-sensing nerves to the brain. It's like turning off a switch. It turns those nerves off for a while.
• An epidural steroid injection involves injecting a medication around the inflamed nerve that is causing the pain. This reduces the swelling and pressure on the nerve, relieving the pain.

Doctors use several methods to inject this medicine.

Single-injection epidurals

This involves a single injection of an anesthetic or steroid. This is often how steroid injections for back pain are given.

Epidurals with a catheter

This involves inserting a thin, flexible tube (catheter) into the epidural space. This tube allows you to give several doses of medication at the right time and in the right amount. This method is often used to control pain in expectant mothers and during long surgeries.

Epidural with a PCA

After some surgeries, a catheter is placed in your epidural space, and a small pump is connected to it. You press a button on this, and you can inject yourself with a safe amount of medication that your doctor has prescribed, whenever you need it. This is called patient-controlled analgesia (PCA).

Combined spinal-epidural (CSE)

This involves giving a mixture of an anesthetic and a steroid through a catheter. This method is often used to control pain during childbirth. It is also called a 'walking epidural', but many people are actually unable to walk. However, they can still move around because they have some sensation in their legs.

How do you prepare before an epidural?

Depending on the reason you're getting an epidural, the preparation you need to do may vary. So it's important to follow your doctor's instructions exactly. Typically, you may be asked to do things like:

• Avoid eating and drinking for a few hours before treatment.
• Temporarily stop taking certain medications (especially blood thinners) and vitamins.
• Arrange in advance for someone to take you home after treatment.

What happens when an epidural is given?

When you are given an epidural, you will be turned on your side and made to lie down, or you will be asked to lean forward and sit up. Then the doctor will follow these steps:

1. First, a cannula is inserted into a vein in your arm, like a saline drip.

2. Then, a small injection is given to numb the area where the epidural was inserted.

3. Next, the epidural needle is inserted into the epidural space in your back. (For steroid injections for back pain, a special camera (fluoroscopy) is sometimes used, similar to an X-ray, to see exactly where the needle goes.)

4. If a catheter is being inserted, a thin tube (catheter) is inserted through the needle and the needle is carefully removed. The tube remains inside the body.

5. Then they start giving the medicine through that tube.

6. When you no longer need the medication (which could be in a few hours or a few days), the catheter will be removed.

Will an epidural cause back pain later?

This is a question that many people ask and something that many people fear.

It is normal for there to be some slight soreness or bruising at the injection site for a few days. This will go away completely in two to three days.

Many mothers experience back pain after giving birth. The reason for this is that the bones and ligaments that were stretched during pregnancy are starting to adjust back to their normal position. This can happen whether or not you had an epidural. So you can't blame the epidural for it.

Are there risks and side effects?

Epidurals are generally very safe, but like any medical procedure, there are some very small risks. However, these are very rare.

• Bleeding from the injection site.
• Infection at the injection site.
• Spinal fluid leak (this happens very rarely).
• Nerve damage.
• Side effects or allergies to medications.

These risks are very low. Your doctor will consider all of these factors and treat you in the safest way possible.

When should you talk to the doctor?

If you experience any of the symptoms below after receiving an epidural, call your doctor immediately, or go to the nearest hospital emergency department (ETU).

It's normal to feel scared when you're told you're going to get an injection close to your spine. But an epidural is a very safe and effective way to control pain. Talk to your doctor about any questions or concerns you have. He or she will explain everything to you.

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