What is an epidural anaesthetic?

An epidural anaesthetic (or epidural) involves injecting local anaesthetics and other painkillers into the epidural space (an area near your spinal cord). This numbs your nerves to give pain relief in certain areas of your body. An epidural can be used either on its own while you are awake, or together with sedation or a general anaesthetic. An epidural can also be used after an operation or procedure to give effective pain relief.

How does an epidural work?

A fine catheter (tube) is inserted in the epidural space, near your spinal cord. Local anaesthetics and other painkillers are injected down the catheter into the epidural space to numb your nerves.

The epidural can be maintained by giving extra doses or by giving a continuous low dose (an infusion).

What will happen if I decide not to have an epidural?

There may be clinical reasons not to use an epidural, such as having an allergy to the type of anaesthetic or materials used, or an infection at the site where the epidural catheter will be inserted.

If you decide not to have an epidural, your anaesthetist may suggest other methods of pain relief.

How is an epidural given?

To insert the epidural catheter, your anaesthetist will ask you to either sit up or lie on your side.

Your anaesthetist will insert the epidural catheter using a needle.

Your anaesthetist will inject a small amount of anaesthetic through the catheter to check the position. Once they have completed this check, they will give more of the anaesthetic until the epidural is working properly.

The effect of the epidural can be varied by changing the type and amount of medication given. The more anaesthetic you are given, the more numb you will be.

How can I prepare myself for the operation?

Keeping warm

It is important to keep warm around the time of the operation. The healthcare team will take steps to keep you warm when you are having the operation.

The hospital may be colder than your home, so bring extra clothing or a dressing gown.

Lifestyle changes

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

What complications can happen?

There is a small risk of significant permanent harm from an epidural.

• the epidural not working properly
• low blood pressure
• headache
• allergic reaction to the equipment, materials or medication
• respiratory depression, where your breathing slows down too much
• itching
• difficulty passing urine
• temporary leg weakness
• backache
• seizures
• unexpected high block, if the local anaesthetic spreads beyond the intended area
• infection around your spine
• cardiovascular collapse (where your heart stops)
• nerve damage
• blood clot around your spine
• damage to nerves supplying your bladder and bowel
• paralysis or death

Late complications

A complication may happen after the epidural has been removed.

• pus, redness, tenderness or pain
• a high temperature
• feeling unwell
• discomfort when in a bright room or sunlight
• neck stiffness
• difficulty moving or feeling your legs
• difficulty passing urine
• bowel incontinence

How soon will I recover?

An epidural can affect your reactions. Do not drive, operate machinery or do any potentially dangerous activities (this includes cooking) until you have fully recovered feeling, movement and co-ordination.

Summary

An epidural anaesthetic can be used for most people, usually giving a safe and effective form of pain relief both during and after an operation or procedure.

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