How Does an Epidural Work?
It’s a catheter that is inserted into your “epidural space,” using a needle, which is right outside of the membrane that protects your spinal cord. Doctors use epidural injections to relieve pain during and after surgery, as well as managing chronic pain.
This procedure isn’t right for every case. But if it’s an option, it requires a lower dose of medicine and as a result has fewer side effects. Epidurals may even give you longer-lasting pain relief while helping you stay more alert and mobile.
Nerve Block Anesthesia
This is one of the most common uses of an epidural. It’s a type of anesthesia that doctors may give you during surgery to numb your spinal nerves and prevent pain signals from traveling to your brain. It usually begins to work in only 10 to 20 minutes.
You’d get a nerve block through a small, flexible tube called a catheter that goes near your spine at the small of your back and delivers the medicine nonstop, so you feel no pain during your surgery.
An epidural targets the nerves that carry pain signals. So you’re still able to feel touch and pressure. In fact, even though you will not feel pain in the lower portion of your body, you may still be able to walk around with some help. For these reasons, doctors usually recommend the use of an epidural nerve block when a woman chooses to get anesthesia during childbirth.
Your doctor will use an X-ray with a special dye to insert the needle in the right spot. They will choose a location along your spine from the bottom of your neck to your tailbone that is closest to the nerve causing your pain.
Conditions that can be treated by an epidural injection include:
The procedure can take as little as 15 minutes, and the numbing part of the shot may start to work fairly quickly. (The steroid part, which lasts longer, should start to work in 2 to 5 days.) The amount of time your pain relief lasts is different for each person. This type of injection doesn’t always bring pain relief. But if it does, the benefits can last up to a few months.
Doctors may also use epidural injections to find the source of your pain. In this case, the injection will target a specific nerve. If it helps ease your pain, your doctor will know they've found the right nerve.
Does an Epidural Hurt?
When you get an epidural, you'll either sit down and lean forward or lie down on your side with your knees near your chest.
Local anesthesia will help numb the skin near the area where you're getting the epidural. You might feel a pinch when you get the anesthesia.
Once you're numb, your doctor will give you the epidural. You might still feel some discomfort as your doctor puts the epidural needle and catheter in. Some people notice pressure, tingling, burning, or a quick shooting pain. But others don't feel anything at all. Most pain goes away after the injection.
If you notice intense and sharp pain during or after your doctor puts in an epidural, tell them right away.
You'll get pain relief medicine through your catheter. This usually takes about 20 to 30 minutes to work.
Mobile epidurals use a lower dose of pain medicine. These allow you to walk around while it's still in.
How Long Does the Epidural Stay in Your Body?
When your doctor inserts the catheter into your body, they'll use a needle to help it go in. Right after they do this, they'll take the needle out.
The epidural needle is longer than a normal shot needle. This is so that it reaches the right area in your body.
The catheter will be the only thing that stays in you. It might stay in for several hours during certain procedures, like giving birth. Or you may keep the catheter in for a few days, like after major surgery.
Epidural analgesia is the epidural doctors use for people who are about to give birth. You won't be put to "sleep" with this epidural. You also won't completely lose the ability to feel and move. It'll only relieve your pain.
With epidural anesthesia, you'll lose feeling in parts of your body so that doctors can perform surgery. This epidural won't make you fall asleep. But your medical team may give you another type of medication to cause you to sleep during the surgery.
What Shouldn't You Do After an Epidural?
After an epidural, it's important to stay away from certain activities for at least 24 hours. Don't:
- Operate any kind of machinery
- Drink alcohol
Your doctor will tell you more about what you should and shouldn't do based on your specific epidural and surgery. Make sure you follow their directions carefully.
Who Shouldn’t Get an Epidural?
There are a number of conditions that may make it risky for you get an epidural:
- Anesthesia drug allergies
- Blood clotting problems
- An infection
- Uncontrolled diabetes
- Some other medications you're taking
Depending on your situation, your doctor might look for another type of pain relief for you, or you might need to wait until a better time for the procedure.
Side Effects of an Epidural
Most of the time, epidurals are safe. But in rare cases, you can have side effects or complications. These include:
- Low blood pressure, which can lead to lightheadedness
- An infection from the epidural
- An intense headache from spinal fluid leakage (Less than 1% of people have this.)
- Chills and shivering-like tremors
- Hot flashes or a rash from the medications
- Bleeding if your doctor accidentally harms a blood vessel during the injection (which could lead to other issues like a blood clot or hematoma, which is a buildup of blood in your body)
- Harm to the nerves around the injection area
- Short-term loss of bladder and bowel control. You may need help from a catheter to pee.
Epidurals for labor and delivery have some other risks:
- You could lose feeling in your legs for several hours.
- It may be hard to push during birth, and you might need help.
- It could slow down the second stage of labor.
- You could have perineal tearing, which is tearing of the skin and muscle around your vagina and anus that can occur during delivery. Other factors like the use of forceps or a vacuum during delivery of your baby can put you at greater risk of tearing.
You doctor will have to watch your baby closely during labor.
Also, some studies have shown a link between epidural analgesia and neonatal respiratory distress syndrome, which is a condition that happens when your baby does not have enough natural liquid in their lungs to keep their airways open. But other studies show no connection. We need more research to confirm this risk.
For injection epidurals, some possible issues include:
- A temporary rise in pain
- High blood sugar if you have diabetes that might last for a few hours or days
- If your doctor uses fluoroscopy or a CT scan, you'll be exposed to a small amount of low-level radiation from the X-rays.
You could also have short-term back pain. It's rare to have any long-term or chronic back pain from an epidural.
It's also very rare, but epidurals can lead to some long-term issues:
- Brain issues related to spinal cord or nerve root damage
- Chronic pain from spinal cord and root damage
- Paralysis from a buildup of blood near your dura mater (the outside layer that keeps your brain and spinal cord safe) and spinal cord