What is epidural anesthesia and when is it performed?

Epidural anesthesia is a method of pain relief that works by blocking nerve endings that transmit pain impulses directly to the brain. Sometimes epidural or peridural anesthesia is called anesthesia, which is not entirely true, because anesthesia completely deactivates consciousness, while anesthesia anesthetizes and the person is awake.

The principle of operation and methodology

As a result of this method of anesthesia, the nerve ending is blocked. The spinal cord and its roots are surrounded by a hard shell, around which is the epidural space along the entire spine. Getting into it, the drug blocks any transmission of pain impulses, which leads to analgesia, that is, to the loss of pain.

At the same time, the technique of epidural anesthesia must be observed very precisely in order to avoid complications that may occur in a patient with an anesthesiologist's poor quality approach.

Stages of

Patient preparation for anesthesia

Preparation is psychological and medical. The latter includes the delivery of tests, including a complete blood count, a coagulogram, a test for the group and the Rh factor, the preparation by the doctor of the necessary tools that will be needed for the operation.

These include:

• alcohol solutions;
• saline;
• needle for puncture;
• catheter;
• patch;
• anesthetic.

The patient takes the desired position, which will open the specialist maximum access to the spine. Most often, for this you need to lie on its side, as much as possible pulling the legs to the chin. Next, the skin in which the puncture will be made is treated with anesthetic, pierced (using local anesthetics). This allows you to make the introduction of the catheter as comfortable as possible.

When the patient is fully prepared, the doctor will puncture the needle, which should reach the epidural space. A catheter with a thin silicone tube is inserted through the needle. Then the needle is taken out, and the catheter is fixed with adhesive tape. Now you can apply medicine.

The effect of this method does not come immediately, you need to wait about 20 minutes. During the operation, you need to constantly monitor the patient's pulse, the work of the heart, lungs.

Sensations during epidural anesthesia in a patient are usually the following: the lower part of the body becomes numb, sensitivity is lost. With a small dosage of the drug a person retains the ability to move, but in any case it is undesirable to do so.

When do they do epidural anesthesia?

The use of this type of anesthesia in medicine is carried out in the following cases:

• obstetrics;
• surgery.

In obstetrics:

• during cesarean section;
• during childbirth to facilitate labor;
• at imposing of postnatal and postoperative seams.

In surgery:

• when removing the appendix;
• when uterus is removed;
• with hernia repair;
• during surgery on the bladder, rectum;
• when performing various types of urological operations;
• during surgical interventions in the perineum;
• during the operation in the cardiovascular system.

In general, this method is used in surgery when general anesthesia is contraindicated in a patient, for example, due to age or for other reasons.

Epidural anesthesia is used to relieve pain, if other methods do not help. For example:

1. With postoperative pain. In this case, the specialist can leave the catheter with the incoming medication.
2. To relieve pain after a severe injury.
3. To eliminate back pain.
4. With the so-called phantom pains that can occur in a person after removing the limbs.
5. With severe pain in the joints.
6. To relieve pain in the treatment of cancer patients.

What drugs are used for epidural anesthesia?

A variety of anesthetics can be used for epidural anesthesia. These include:

• Novocaine;
• Clexane;
• Markain;
• Bupivacaine;
• Lidocaine;
• Naropin;
• Dikain.

All of them differ in time of exposure, and in properties, and contraindications. Most often, the doctor prescribes an anesthetic that will suit the particular patient, taking into account individual characteristics, test results.

Advantages and disadvantages of this method

The advantages of epidural anesthesia include:

1. If we talk about issues of obstetrics, the main advantage is that during childbirth a woman will remain conscious, she will be able to listen to the recommendations of the doctor and see her child immediately after giving birth.
2. If we talk about the technique as a whole, capturing the whole range of its use, the quality and duration of anesthesia can be attributed to the pluses. Anesthesia lasts until the specialist stops feeding the medication and removes the catheter.

In addition, a number of drugs that are used for anesthesia, promote muscle relaxation, which is necessary for carrying out complex operations. This will greatly facilitate the work of the doctor and will not use general anesthesia that is harmful enough for the body. In addition, the use of this method ensures stable operation of the heart and blood vessels.

There are also disadvantages:

1. However, it is worth remembering that the drug enters the body through a catheter. Because of this, the risk of an overdose of the anesthetic drug is not excluded. This can cause a sharp drop in pressure, cramps, and depressed breathing.
2. By mistake, the anesthetic doctor may enter the subarachnoid space. Using small doses will not affect the patient's condition, but with prolonged epidural anesthesia, such a medical error can lead to cardiac arrest and respiration.
3. An anesthesiologist must have training and skills to perform this procedure. Not every medical institution can find such a specialist.
4. In about 10 cases out of 100 after the drug is injected, the patient will still experience pain. This may cause re-introduction of anesthesia or the need for general anesthesia.

Indications and contraindications

Indications for use in caesarean section:

• high pain threshold in women;
• abnormal course of labor;
• preterm delivery;
• multiple pregnancy.

In other cases, the main indication is the inability to use general anesthesia, for example, when performing an operation for an elderly patient or if general anesthesia can cause serious harm. Another indication is high blood pressure.

If the procedure is carried out in such conditions, there is a high risk that the infection will spread sufficiently to hit those areas of the body, inflammation of which will cause serious consequences.

Other contraindications include:

1. Acute infectious pathology or exacerbation of chronic diseases.
2. The absence in the medical institution of the necessary equipment for the procedure. For example, in the absence of an apparatus for artificial ventilation of the lungs.
3. With the appearance of various types of complications.
4. Also referred to as contraindications is the risk of severe bleeding during puncture, which happens with poor blood clotting, low platelet count, high white blood cell count, etc.
5. Some pathologies of the spine, for example, intervertebral hernia, osteochondrosis, which is accompanied by severe pain.
6. Heart arythmy.
7. Low blood pressure. In this case, blood pressure tends to drop significantly.

Recovery after epidural anesthesia

Sensitivity in the limbs after cessation of the drug is returned within two to three hours. It also depends on the dosage of the administered drug. According to experts, after anesthesia, the patient must be in a horizontal position for at least 24 hours.

Bed rest is also necessary in case of headache, which is a frequent complication of this procedure. After a day the patient can already get up.

Causes of inefficiency and possible complications

Success with an epidural blockade depends on a number of factors. A low level of analgesia may be associated with a small dose of the drug, early onset of the operation, and individual patient characteristics. In some cases, the effect may not occur due to the deviation of the movement of the catheter in the median line. In this case, the anesthesia will be either one-sided or very weak. In this case, the patient must be turned over to the side with insufficient anesthesia and the drug is reintroduced.

During the operation on the lower extremities, an insufficient blockade of the lower spinal cord is possible due to the large size of the spinal roots. To eliminate this disadvantage, you must enter the first dose of the drug in a sitting position or add anesthetic. When perforation of the dura mater, it is possible to use a special catheter. In some cases, doctors re-conduct an epidural puncture.

A dangerous but rather rare consequence of anesthesia is the catheterization of the subdural space. In this case, the cerebrospinal fluid will not flow out, because of which it is quite difficult to notice the complications. The consequences include:

• high unilateral blockade;
• loss of sensitivity while maintaining motor function.

The reason for errors and poor anesthesia may be a false sense of loss of resistance due to the softness of the ligaments. This is especially noticeable in people of young age, in patients with cystic degeneration of the ligaments.

Epidural anesthesia is a reasonably safe option for anesthesia, in which complications are rare.

Among the consequences:

• inadequate analgesia or complete absence in approximately 5% of cases;
• hematoma formation is more common in patients with coagulation disorder;
• toxic effects of anesthetics;
• damage to the dura mater;
• hypotension;
• respiratory depression;
• nausea, itching and vomiting.

Some patients complain of a headache after the procedure. This may be caused by the ingress of cerebrospinal fluid into the epidural region. Headaches can be long, intense, but usually disappear within a few hours.

Features of epidural anesthesia during childbirth

Anesthesia is increasingly being used in obstetrics around the world. In many countries, a woman is obviously ready that natural childbirth using epidural anesthesia will be as painless and comfortable as possible. This type of anesthesia is used in the following cases:

• at birth twins;
• on heavy gestosis;
• with discoordinated labor;
• when using obstetric forceps;
• in the presence of severe concomitant diseases, such as diabetes, hypertension, liver and kidney disease.

Any childbirth can be a reason for carrying out this type of anesthesia, even without the reasons listed above. The main thing is the absence of contraindications. Also, the woman must give her written consent to the use of anesthesia.

During anesthesia during labor, the epidural space is punctured at the level between the third and fourth lumbar vertebrae. Anesthesia begins at a time when the cervix is ​​opened at least 5 cm. The most commonly used lidocaine up to 12 ml in the first stage of labor. By the beginning of the birth of the baby enter the same amount. Also, epidural anesthesia is performed at caesarean section. Today, this operation involves a high blockade at level 4 of the thoracic spine due to the duration of the procedure (it can last more than an hour), due to incisions.

Lower anesthetic administration can cause pain and nausea, vomiting during anesthesia. If epidural anesthesia is supplemented with general anesthesia, the blockade is first carried out, the effectiveness evaluated, then general anesthesia is used. The advantages of epidural anesthesia in obstetrics are its high efficacy, the minimum of negative consequences for the child, provided the device is properly selected, and its dosage.

The advantages can also include the comfort and tranquility of the mother. The undoubted plus of anesthesia for caesarean section is the presence of the mother during labor, because the woman remains conscious. However, there may be some negative consequences. For example, often there is a feeling of heaviness in the legs, anemia, which pass after the end of the drug. A shiver may appear, it does not pose a health hazard, but it does cause some discomfort. Short-term hypotension is also possible. Among the rare complications include allergies, respiratory failure, anesthetics entering the blood vessels, nerve damage.

In the next two days after anesthesia, a woman may experience a headache. Also, some patients complain of back pain. These discomfort usually disappear within 2-3 days after the intervention. Epidural anesthesia can be attributed to modern methods of anesthesia, which is successfully used in large medical centers and municipal hospitals.

The main condition for successful conduct is the experience of the anesthesiologist, who has enough knowledge and skills in carrying out such operations. You need to carefully calculate the dose, choose the right drug - in this case, provides reliable protection from pain, operational stress. And recovery after this intervention is an order of magnitude shorter and easier than with general anesthesia.

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