What is an epidural?
An epidural infusion is one of the many methods of delivering medicine for pain relief after an operation. After your operation it is normal to have pain from the cut made by your surgeon. It is important to stop strong pain because this may lead to other problems such as blood clots in the legs and infections due to reduced mobility. An epidural is an effective method of controlling pain. A thin plastic tube, no larger than a fishing line, is inserted into your back so that local anaesthetic can be delivered to numb the nerves going to your cut. Numbing the nerves decreases your pain by blocking messages from your spine to your brain.
Who will perform the epidural?
When you are in the operating theatre a specially trained doctor (anaesthetist) will perform your epidural. The doctor will inject
some local anaesthetic under the skin to numb the area. A special needle is then gently inserted into your back until the epidural space is found. The epidural space is an area around the spinal cord where the nerves collect before going towards your hands and feet. The anaesthetist will insert a small plastic tube (catheter) into the needle, into the epidural space. The needle is then removed leaving the plastic tubing in your back. The tubing is then fixed to your back with tape and attached to a pump. An infusion of pain medicine (local anaesthetic and another pain reliever) will run continuously via the pump at a specified rate, which is ordered by the doctor.
Is having an epidural safe?
Epidurals are safe and effective, but like all medical procedures, do have some risks. Specially trained doctors and nurses
continually monitor your progress to ensure the epidural is working safely and effectively. Side effects and complications
are still possible, however serious complications such as spinal cord problems are very rare.
What are the side effects?
We cannot guarantee that the epidural will work properly or that no side effects will occur.
The more common side effects include:
Leg weakness and numbness. This occurs when the local anaesthetic blocks the nerves that provide feeling to your legs.
Light head or dizziness caused by low blood pressure
Difficulty urinating. Depending on your operation, this is generally not an issue as a urinary catheter is normally inserted into your bladder during your operation.
The more uncommon or rare complications include:
Infection at the insertion site
A hematoma (blood clot) at the site
Local anaesthetic toxicity
Permanent nerve injury
How long will I have an epidural for?
Everyone is different. It may be 2 to 4 days depending on the type of operation you have and your progress. It is not advisable
to leave the epidural in for any longer than 4 days unless the benefit of leaving it in outweighs the risk of infection, (which increases the longer it is left in). When the epidural is stopped, the doctor will order you other medication to help relieve the pain
What are the benefits to having an epidural?
Epidurals can give you better quality pain relief than other methods. Good pain relief can allow you to be more mobile and can
make it easier for you to attend to deep breathing and coughing exercises. This may prevent other complications of surgery
and allow you to get better more quickly. An epidural may reduce the drowsiness and nausea that occur with other methods of pain relief.
Who is most likely to benefit from an epidural?
Patients with a history of difficult to control pain following past surgery, those with moderate to severe breathing complaints
(such as emphysema, or asthma), or very obese people are most likely to benefit from an epidural. Patients having chest surgery, abdominal surgery, very extensive surgery are also more likely to benefit than those having minor procedures.
Can I change my mind?
If you choose not to have an epidural and you experience severe pain after your surgery that cannot be well controlled with a
“morphine drip”, an epidural can usually be inserted. There may however be a significant delay as it is not safe to insert an
epidural within 12 hours of the blood thinning medicine which is commonly used after major surgery.
Will the doctors and nurses know how much pain I have?
Yes, nurses caring for you will ask you regularly while you are in hospital about your pain. The Acute Pain Service will be
responsible for your pain management after your operation, and will check on your progress daily.
The doctors and nurses will ask you to rate your pain using a score out of 10.
0 out of 10 means no pain and 10 out of 10 is the most severe pain you can imagine.
During the time that you have an epidural the nursing staff will also assess the spread of local anaesthetic from the epidural by doing an ice test. The ice test consists of the nurse using a piece of ice and placing it up and down your body. The nurse will ask you to tell him/her when the sensation feels cold. This enables the nurse to work out whether the epidural is working and what area of your body it is working on.
It is important that you let the nursing staff know when you are developing pain. Pain might occur if the dose needs adjusting or if the epidural moves out of position. Your nurse is able to give you a little more medicine (bolus) down the epidural to help
relieve the pain. This usually takes about 15-20mins to work. If this doesn't help the nursing staff will notify the on-call anaesthetist to review you.
Things to tell your nurse
To ensure the epidural is working effectively it is important to tell the nurse a few things. These things include
Any increase in pain
Numbness or tingling in you hands
Numbness and weakness in your legs.
Inability to urinate.
This information is only a guide on epidurals.
If you have any further questions regarding your pain relief, feel free to discuss these questions with your anaesthetist at any time.