When you're about to give birth or have a major surgery, it can be a little scary when the doctor tells you that you'll need an epidural. Many people get nervous when they hear the word "epidural" and it's an injection into the back. But what exactly is an epidural? What does it do? Is it something to be afraid of? Let's understand this clearly and simply.
Simply put, what is an epidural?
An epidural is an injection into the space around the nerves in your spine (the epidural space) . It is not injected directly into the spinal cord. It is only injected into the space around it. It is mainly used to control pain.
Here are some cases where this is used:
- Control excessive pain during childbirth .
- Numb the area (anesthetize) before surgery.
- Reduce pain after surgery.
- As a treatment for chronic back pain caused by conditions such as a herniated disc.
What are the types of epidurals?
There are two main types of epidurals that doctors use, depending on your needs.
| Epidural type | Description and use |
|---|---|
| Epidural Anesthesia | This involves injecting an anesthetic to numb pain and sensation. It is used to numb pain during childbirth and surgery. |
| Epidural Steroid Injection (ESI) | This involves injecting a steroid (corticosteroid) into the nerves to reduce swelling and inflammation. It is often given for chronic pain. The effects can last for weeks or months. |
How does this work?
The way an epidural works varies depending on the type you are given.
Epidural anesthesia temporarily blocks the transmission of pain signals from your spinal nerves to your brain. This means that the nerves are "turned off" for a while. The duration of the effect depends on the amount of medication given.
An epidural steroid injection (ESI) reduces swelling and pressure by injecting medicine around the inflamed nerves that are causing pain.
Different ways of giving medicine
Doctors, there are several ways to inject this medicine into your body.
- Single-injection: This is a one-time injection. This is how steroid injections (ESI) are often given.
- Epidural with a catheter: A catheter is a very thin, flexible tube. This tube is placed in the epidural space and can be used to give medication as often as needed. This method is often used during childbirth and in surgeries that last several hours.
- Patient-Controlled Analgesia (PCA): This is also a method of giving pain medication through a catheter. But you can get the pain medication yourself by pressing a button on a small device in your hand. This only gives you a safe dose determined by your doctor, so there is nothing to worry about.
- Combined Spinal-Epidural (CSE): This method is most often used during childbirth. Some people also call it a "walking epidural." However, you won't be able to walk at all. However, you will have some sensation in your legs, so you can move around in bed and change positions.
Do I need to prepare before an epidural?
Yes. But the things you need to do will vary depending on the type of epidural you are having and the reason for it. Your doctor will give you clear instructions about this. You may usually be asked to do the following:
- Fast (abstain from food and drink) for a few hours before the procedure.
- Temporarily stop taking any medications you are taking, especially blood thinners .
- Arrange in advance for someone to take you home after the procedure.
What happens when an epidural is given?
This also varies depending on the type you are given.
If a single injection is given:
You will be asked to lie down on your stomach. Then the doctor:
1. A small injection is given to numb the skin around the injection site.
2. Fluoroscopy , a machine like a live X-ray, is used to make sure the needle is going exactly where it should be.
3. The needle is inserted into the epidural space and the medicine is injected.
4. The needle is removed and a small plaster is applied to the injection site.
If a catheter is inserted:
1. A cannula (IV line) will be inserted into a vein in your arm to give you saline.
2. You will be asked to lie on your side, with your knees drawn up to your chest, or to sit in a chair and lean forward. This position will increase the space between your spine.
3. The injection site is numb.
4. The epidural needle is inserted and the catheter (thin tube) is passed through it into the epidural space.
5. Then the needle is carefully removed, leaving only the catheter inside.
6. The necessary medication is administered through that catheter.
7. When the need for medication is over (after a few hours or a few days), the catheter is removed.
What are you feeling right now?
You may feel a little pain when you first get the numbing injection. When the epidural needle is inserted, you may feel a tingling, numbness, burning sensation , or a brief electric shock. Some people may not feel anything at all. This discomfort will go away once the injection is complete. However, if you experience unbearable, sharp pain, tell your doctor immediately.
What are the benefits and risks of an epidural?
An epidural is a very safe and effective method of pain control. During childbirth, it is more flexible than other anesthesia methods. It also has relatively few side effects. For those with chronic pain, it can even avoid things like surgery if the pain is controlled.
As with all medical treatments, there are some risks. But remember, serious complications are very rare .
Possible risks:
- Bleeding from the injection site.
- Infection at the injection site.
- Damage to a nerve (very rare).
- Allergic reaction to the medicine.
- Leakage of fluid around the spinal cord (`Cerebrospinal fluid leak`). This can cause a headache later.
Will the epidural cause back pain later?
This is a big fear for many people. Remember that it is very rare for an epidural to cause long-term or chronic back pain .
It is normal to have temporary pain or bruising at the injection site for a few days. This will go away in two to three days. Many mothers experience back pain after giving birth - whether they had an epidural or not . This is because the hip bones and ligaments that changed during pregnancy are adjusting to their new positions.
When to see a doctor
If you have any of the following symptoms after an epidural, call your doctor immediately or go to the nearest hospital emergency department (ETU) .
| Symptoms to watch out for |
|---|
| • Fever. |
| • Inability to control urine or stool (Urinary incontinence / Fecal incontinence). |
| • Numbness or weakness in the legs lasts longer than the doctor prescribed. |
| • Severe headache that occurs when standing or sitting, and subsides when lying down. |
It's normal to feel scared when you hear the word "spinal tap." But an epidural is a very safe and effective method of pain management that is widely used around the world. So don't be afraid to talk to your doctor about any questions or concerns you may have about this.
Take-Home Message
- An epidural is a very safe and common injection for pain control.
- This is not given to the spinal cord, but to a special space around it (epidural space).
- It is used for childbirth pain, surgical pain, and chronic pain.
- Serious side effects are very rare. Mild soreness at the injection site for a few days is normal.
- It is often a misconception that an epidural causes long-term back pain.
- Talk openly with your doctor about any doubts or fears you have.
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