Epidural and Spinal

Epidural and Spinal Anesthesia are called “neuraxial anesthesia” and are commonly used for surgery, for pain relief after surgery, and for women in labor.

Epidural – An Epidural is given into your back (outside the spinal cord) by means of a very fine plastic tube, also called a catheter, which is inserted through an epidural needle (the needle is removed after the tubing is in place).  Local anesthetic and other pain relieving medications are given through the tubing near the nerves in your back to decrease pain.  It works by blocking the pain signals from reaching your brain.  The fine plastic tube is taped onto your back and drugs can be given through this fine tube for anywhere from hours to days.

You may have a continuous slow infusion or you may be given a button to push to give yourself a dose of the pain relief medication as you need it.  This is called Patient Controlled Epidural Analgesia (PCEA).

Spinal – A spinal anesthetic is performed by administering a single injection of anesthetic medication into the spinal fluid of your back using a very fine needle.  This medication blocks the pain signals from reaching your brain.  It also blocks the movement signals, resulting in a temporary loss of movement in your legs while the spinal is working.  This type of anesthesia is quick to work (usually within 5-10 min) and the numbness lasts from 1-4 hours.  Additional medications may be given which reduce pain for up to 24 hours.  In most cases you can sleep through the surgery as well by the anesthesiologist administering sedation or a general anesthetic.

 Potential Benefits of Epidural and Spinal Anesthesia

•   Better pain relief than IV narcotic drugs alone

•   Less narcotic related side effects such as nausea, sedation, and constipation

•   Less risk of lung complications, including infections

•   Faster recovery of bowel function after surgery

•   Improved blood flow after vascular surgery

•   Decreased risk of blood clots after surgery

•   A quicker return to eating and drinking after surgery

Risks – Modern anesthesia is generally very safe. Every anesthetic has a risk of side effects and complications. While these are usually temporary, some may cause long-term problems.

Most Common Side Effects  (risk ~1/10- 1/100) of Epidural and Spinal Anesthesia

•   Nausea, vomiting, itching and shivering

•   Low blood pressure

•   Temporary backache and/or bruising at the injection site

•   Partial or inadequate pain relief

•   Problems in passing urine, usually temporary, but for a few men it may require a consultation with a urological specialist

Less Common Side Effects and Complications of Epidural and Spinal Anesthesia

•   Severe headache – if this happens you may require bed rest for several days.  Sometimes another injection, called a ‘blood patch’ is needed to treat this headache

•   Intense itching

•   Hematoma or bleeding.  Always tell your anesthesiologist if you take blood thinning medicines such as Aspirin, Warfarin, Xaralto, or Plavix and notify them when your last dose was.

Recovery from your spinal or epidural anesthetic –  The numbness and weakness may take several hours to wear off.  During this time, do not attempt to walk.

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