Tuesday, February 21, 2006


DrWho could use some help. She's made up a pamphlet... sort of a FAQ on Epidurals. She'd like to get some feedback from some non-medical types. Let us know what ya think... helpful? not helpful? Idealy this will be given to pregnant women when at their first OB visit. Right now, there is literally no information on anesthesia being given at all.

Will labor be painful?
The pain experienced during labor is different for every woman, but most women will experience some pain.

What is an epidural?
An epidural is a tiny catheter that lies in your epidural space (right next to your spinal cord) that is capable of delivering medicine (a local anesthetic) that numbs the nerves that carry the pain sensations from labor.

How common are epidurals?
Here at WVU, __% of laboring patients receive an epidural. Approximately one hundred million women each year get a labor epidural.

What are some reasons that I could not get an epidural?
Unless delivery is imminent, you cannot be too far along to have an epidural. As long as you are going to deliver the baby during this hospitalization, there is no such thing as not dilated enough to have an epidural. However, if you are not dilated to at least 3-4cm, then the epidural may make labor last longer. If you have a pregnancy related condition called pre-eclampsia, a blood laboratory test to determine your blood’s clotting ability will have to be completed. If your blood does not clot well, then you would not be a candidate for an epidural. If you are on blood thinners or have severe liver disease, then you might not be a candidate. If you have symptoms of a blood infection or a rash in the small of your back, then you might not be a candidate. HIV is not a contraindication for an epidural.

What can I expect during the placement of the epidural?
First, your anesthesiologist will ask you some questions to make sure it is safe for you to have an epidural and get your permission. Then, you will be given some fluid through your IV. You will most likely be sitting on the edge of the bed facing away from the anesthesiologist. You will have some monitors placed (blood pressure cuff on your upper arm and a clip on your finger). The anesthesiologist will press on your back feeling for the right space. He will then clean off your back with a cold cleaning solution. A drape will be placed on your back. He will then put some numbing medicine under your skin with a small needle. You will usually feel a little pinch and then a stinging sensation that goes away very quickly. After that, you might feel some pressure sensation or a twinge down one of your legs. Both of these sensations are normal, but let your anesthesiologist know if you have them and which side you felt it on. Also, let your anesthesiologist know if you feel like he is working on the left or the right instead of directly in the middle. The anesthesiologist will use an epidural needle to find the epidural space, and then place the epidural catheter through the needle. He will then remove the needle leaving only the catheter. The catheter will be taped into place and a test dose of medicine given. If the test dose is negative, you will lay back down. After you get a bolus of medicine through your catheter, your legs will go numb and be difficult to lift. Your contractions will get shorter and less intense. It may take 10 to 20 min for the pain from your contractions to go away completely. The time from the first needle stick to the time you are comfortable is on average blank minutes here at WVU. Blank% of patients here at WVU thought that the procedure was better than they expected.

Is there a way to test the epidural?
Epidurals are a “blind” procedure, meaning we cannot actually see where the catheter goes. We give a test dose of medicine to better guide us to the accurate placement of the catheter. The signs and symptoms we are looking for after the test dose of medicine include a buzzing in your ear, numb lips, dizziness, and numb legs or buttocks.

What are the side effects?
The most common side effect is hypotension (low blood pressure). Blank % of our ladies here at WVU experience significant hypotension. Fluid through your IV is given to prevent this; also, there are medications that we can give if the blood pressure gets too low. Hypotension can cause nausea (sick at your stomach). Nausea occurs about 20-30% of the time. Backache after labor and delivery is a common side effect. This can be from several causes including pushing, straining, or an epidural. About 18% of patients having epidurals will develop a backache. This is thought to occur from the bruising from the needle stick. This will usually go away in a few days to few weeks. Depending on the medication your anesthesiologist uses, itching may be a side effect. Certain kinds of medicine can be given to help with the itching. If you have a history of cold sores, then let your anesthesiologist know because it may prevent him from being able to use a certain type of medicine. The next most common side effect is a headache at about 1%. This is from spinal fluid being encountered during the procedure. This is not dangerous for you or the baby; doctors sample spinal fluid for diagnostic purposes all the time. Your anesthesiologist will let you know after the epidural is placed if this is a complication that is likely to occur. Even if spinal fluid is encountered, only 60% of patients develop a headache. A technique similar to an epidural called a blood patch is 85-90% effective for alleviating the headache. Even if you don’t want the blood patch, most headaches will go away in a week or two. Occasionally, patients will experience shivering; however, patients without epidurals also experience shivering.

What are the risks from an epidural?
All of these risks are so low that no one is able to give an accurate percentage of likelihood that any of these will happen. Complications include bleeding, infection, urinary retention, seizure, difficulty breathing, epidural abscess, allergic reaction, nerve damage including paralysis, high spinal and cardiovascular collapse resulting in death. A high spinal is where medicine travels too far up your back and it effects the muscles you use to breathe which makes it difficult for you to breathe. We may have to breathe for you and possibly do an emergency caesarian section, but this is extremely rare. Another very rare risk is an epidural hematoma, which is a pocket of blood pressing on your spinal cord. This complication, if accompanied by neurological symptoms, would require surgery on your back to prevent permanent damage. Epidurals may increase your temperature to a low grade temperature, but this is not from infection.

Will an epidural increase my chances of needing a caesarian section or slow down my labor?
Although it is a frequent topic of debate, there is no scientific evidence, despite extensive studies, to show that epidurals increase the rate of caesarian sections or instrumental deliveries such as forceps or vacuum deliveries. Epidurals may slow down early labor by 20-40 minutes if it is placed when you are less than 3-4cm dilated. It does not slow down labor if you are past 5 cm dilated. It can sometimes even speed labor up because it allows you to relax more when you are not in pain.

What is a Combined Spinal-Epidural?
A combined spinal-epidural is where in addition to a normal epidural, a small amount of medicine is also placed in your spinal fluid. The advantage of this is that you will get almost immediate relief of your contractions with minimal to no leg weakness.

Can I have a walking epidural?
Although we have several techniques here a WVU to minimize your weakness in your legs, we do not currently allow laboring mothers, even with the best of motor control, to get out of bed. It is too important to have continual monitoring of the baby.

What are the benefits of an epidural?
Wonderful pain relief! With adequate pain control, you can rest before you have to push. Some ladies are so comfortable that they actually sleep! You are able to breathe better which improves oxygen supply to your baby. Laboring patients who choose to go with narcotics through their IV are not allowed to have any more medicine when it gets close to time to have the baby for fear that the baby will have breathing problems upon delivery. With an epidural, you will have good pain control during labor and even through delivery. The epidural does not need to be stopped when it is time to have the baby. Good pain control just makes the birthing experience more satisfactory and even enjoyable. Also, in the event that you may need an emergency caesarian section, your epidural can be used for a quick anesthetic. The epidural can also be used if you want your tubes tied.

Will the baby get any of the numbing medicine?
The babies of mothers with epidurals are exposed to a very tiny amount of the medicine; however, it is much less than babies of mothers who had intravenous narcotics such as Demerol Fentanyl, or Nubain. Studies have shown that there is no difference between babies born by moms who had epidurals and moms who did not have epidurals when comparing sleeping, nursing or pooping. Your baby will not be born numb!

Do epidurals ever fail?
About 10% of epidurals will fail. There are several techniques that your anesthesiologist can use to try and salvage the epidural without having to replace it. About half of those that fail will not need to be replaced. If delivery is not imminent, the epidural can be replaced. Some ladies experience “hotspots.” These are small areas, usually on your abdomen, that are not completely numb. Sometimes epidurals are one-sided. This is where only your left or right side is numb. There are techniques that can improve this, or the epidural can be replaced. As it comes time to push, you may have a pressure sensation. This may be uncomfortable. However, it is a good sign that you are close to having the baby and that you will be able to feel each time you need to push, which is a good thing.

Will I be able to control the amount of medicine I am getting?
Here at WVU, we have what is called a PCEA (Patient Controlled Epidural Analgesia). It has a button attached to the pump that is continually giving you medicine through your epidural catheter. You can push the button to give you extra medicine. As long as you are uncomfortable, you cannot overdose yourself because there is a lockout. However, you should not push the button if you are not in pain. Only you know if you are uncomfortable, so only you should push the button

No comments: