Making the Rounds: Epidural

Most commonly associated with labor and delivery, epidurals can be a tremendous tool for pain relief. We invited Anthony Cheng, MD, PPG – Anesthesiology, to tell us more about the technique and how the medication helps the patient.

When would a patient receive an epidural?

We use epidural most commonly for women in labor. The medication can take the labor pains away within 10-15 minutes.

What is the process for administering the epidural?

We clean off the skin rigorous manner, numb with mosquito bite of local anesthesia so needle going in isn’t felt, then carefully slowly feel different tissue planes, past certain ligament goes in and we know epidural space, cathedral goes in to deliver medication, bathes nerves in anesthesia. Flows downhill.

What should patients expect?

When it’s time to place the epidural, you will need to hold very still and stay in a certain position, which makes it easier for the anesthesiologist. Once the epidural and medication go in, everything gets warm and mellow. Within a few minutes, people in tremendous pain are often ready to take a nap. Depending on which local anesthetic the doctor uses, your legs could be heavier. Motor strength and balance will be altered, but come back as the medication wears off.

How does an epidural work?

We’re basically placing a block into the spinal area using a small catheter, similar to an IV, then releasing medication to prevent pain from the waist down.

Epidural medications are gravity sensitive, so if the catheter goes to one side or medications go to one side, a nurse will move the patient so the medication can go to the nerves where it is needed. I compare it to irrigating crops; you have to get flow where you want it.

Why does the medicine often feel cold when it goes in?

When medicine enters the body, it is at room temperature. The average body temperature is around 98 degrees, so something at room temperature could feel chilly. Most people don’t feel the medication.

How long does it take for the epidural to wear off?

An epidural can last 20-24 hours or several days, if necessary. It’s a matter of placement and medication selection. Once the epidural is removed, the sensation should return within 30 minutes to 2 hours.

Sometimes patients experience tingling in the legs and loss of strength. Very rarely we see people shaking slightly. The best advice is to stay busy. Hold your baby, watch television, visit with loved ones. It will wear off soon.

Are there any risks with epidural?

We will not administer an epidural if the patient is having problems with clotting or bacteria in the blood. Risk of paralysis from an epidural is extremely minimal. Every now and then the needle can tweak a nerve and give the patient a sensation of shock.

Epidurals are very safe for baby. In fact, having an epidural increases blood flow to the uterus and can help with the flow of the labor. The medication only stays in the epidural space and very little goes into the bloodstream.

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