How is epidural anesthesia performed? Epidural anesthesia: consequences, contraindications, complications, reviews

Epidural anesthesia refers to a type of regional anesthesia in which a pharmacological drug is injected into the spine using a catheter. With this anesthesia, a medication is injected into an area near the nerve roots.

Depending on the type of drugs used, epidural anesthesia can achieve different levels of pain relief. With analgesia, complete loss of pain is achieved. If there is no pain and sensitivity disappears in a certain area of the body, then anesthesia is performed. With the help of other pharmacological drugs, muscle relaxation is achieved, this leads to muscle relaxation.

Like any treatment method, epidural anesthesia has both indications and contraindications. Although in recent decades the method has been used to facilitate childbirth, as it is quite safe and effective. But at the same time, it represents an intervention in the body, and this is always fraught with consequences.

What is an epidural method of anesthesia?

The cerebrospinal fluid of each person is located in the spinal canal, which is protected by a special tight membrane consisting of connective matter. This sheath contains nerve endings that begin in cerebrospinal fluid. Space between pleura spinal cord and the walls of the spinal canal itself received the name epidural, which translated means “near, outside.” It is in this area that they inject pharmacological drug, intended for local anesthesia. It serves to “freeze” nerve endings, and the manipulation itself is called “epidural”.

Every year there are improved and more safe means this option of anesthesia, which allows doctors to choose the most suitable medication for each individual case in practice.

The most commonly used method is a continuous method of epidural anesthesia, in which an anesthetic is continuously injected into the spinal space. This achieves constant process withdrawals pain syndrome, and this option involves using a smaller amount of medication.

Another type of such anesthesia is the periodic use of epidural anesthesia. With this type of anesthesia, a pharmacological drug is administered to the patient only when there is a real need for it. This method is used, for example, during labor pains. It is generally accepted that this method not very pleasant, since its effect occurs in waves.

In addition, there is a process of epidural pain relief at the request of the patient. In this case, a special button is placed under the patient’s hands and, if necessary, he presses it himself, as a result of which a certain dose of medication enters the epidural area.

In some cases, a mixture of analgesics and anesthetics is used. This allows you to achieve the desired balance of mobility and sensitivity, but does not always guarantee the desired result.

Doctors highlight modern drugs, which retain sound mind and mobility, but completely stop painful sensations. When using such medications, patients can move around. These drugs are considered optimal for childbirth, as they minimally interfere with the process, and children are born mostly healthy.

Use during childbirth

For an accurate puncture, the doctor first palpates lumbar vertebrae. This is the most main stage, on which the effectiveness of the anesthetic depends. Typically, the drug is administered between the second and third, third and fourth, or fourth and fifth vertebrae, which are located in the lumbar region.

During pain relief, the patient should always talk to the obstetricians about the presence of contractions. In addition, it is necessary to inform the anesthesiologist about all changes occurring in the body at this moment. This may be a slight ringing in the ears, attacks of nausea, a metallic taste in the mouth, numbness in the jaw area, etc.

Before inserting the catheter, the skin around the puncture is thoroughly disinfected, after which a thin needle is inserted to numb the skin and the area between the vertebrae. Upon administration, a short-term burning sensation may occur. Then a special needle is inserted into the same place and pushed into the epidural area, but the patient no longer experiences pain. As the needle advances, the woman in labor should remain motionless and calm. When the needle reaches the target, the syringe will be disconnected and a special plastic catheter will be inserted.

After installing the catheter, the needle is removed. To ensure that the device is installed correctly, a small amount of anesthetic is injected. The catheter attached to the upper arm will remain until the end of labor. The anesthesiologist attaches an antimicrobial filter to it, to which is attached an automatic dispenser in the form of a syringe.

Although the manipulation looks quite complicated, it is painless.

Unpleasant sensations are present at the time of the first injection, the pain begins to subside after 5-15 minutes.

Pros and cons of the method during childbirth

During childbirth, epidural anesthesia has both pros and cons. Wide Application in obstetrics is explained by the fact that this type pain relief is considered the safest for mother and baby. Despite this, there are also negative aspects that you need to be aware of.

Indications for epidural anesthesia during labor are as follows:

reduces the manifestations of pain during contractions;
provides the woman in labor with the opportunity to rest;
reduces the level of the hormone adrenaline in the blood;
with high blood pressure, reduces it;
the best method of pain relief for caesarean section;
makes it easier for the cervix to open, facilitates pushing;
better systemic use drug Promedol.

This type of anesthesia is much preferable general type. After birth, the baby can be immediately attached to the mother's breast, the woman's recovery occurs faster.

Why is epidural anesthesia harmful for a woman in labor?

if there was an accidental puncture of the spinal cord membrane, the woman experiences prolonged and severe headaches;
your back may hurt for many months after the baby is born;
a decrease in blood pressure is possible, which will require the administration of drugs intravenously;
You may need to use the hormone oxytocin (especially if the pregnant woman is giving birth for the first time);
there is a risk that forceps and vacuum extraction will be needed, and this can cause injury to the newborn;
if pain relief has been carried out much ahead of schedule and during the first birth, then there is high probability subsequent caesarean section;
pain relief occurs in certain parts of the body;
may cause urinary retention after the baby is born;
a young mother may have a fever of up to 39ºC due to disturbances in the body’s thermoregulation; it is difficult to reject the possibility of infection and will most likely have to take antibiotics after childbirth;
may complicate the course of pushing;
there is a risk of itching of the face, neck and chest;
there is a possibility of infection during puncture and long-term use of the catheter and the development of septic meningitis;
the occurrence of a hematoma due to vascular damage;
the likelihood of spinal cord injury due to the administration of medication under pressure;
risk of an allergic reaction to anesthesia medication.

Negative consequences for the child:

Ventilation may be required due to respiratory problems;
the heart rate often falls due to a drop in maternal blood pressure and a decrease in uteroplacental blood flow;
Sucking is often difficult and motor skills are impaired.

Indications and contraindications for the use of epidural anesthesia

In modern medicine, this method of anesthesia is considered to be the best for operations on the lower extremities. When using it, you can achieve not only minimal blood loss, but also completely eliminate pain and relax the muscles.

Indications for epidural anesthesia may be of the following nature. This type of pain relief is absolutely safe for the kidneys, prostate gland, ureters, Bladder and liver. Epidural anesthesia is used for abdominal cavity and pelvic organs. Due to the fact that this method of pain relief helps reduce smooth muscle gastrointestinal tract, it is widely used in surgical operations on the stomach, spleen, intestines and bile ducts.

Epidural anesthesia is indicated for use in cases of kidney disease, defects and other heart diseases, and diabetes mellitus.

There are two types of contraindications to epidural anesthesia: categorical and relative.

The first group includes:

tuberculous spondylitis and its complications;
inflammatory processes on the skin of the back;
traumatic shock condition;
increased sensitivity of the body to topical drugs;
pathologies of the central nervous system;
severe spinal deformity;
violation of the blood clotting process;
intestinal obstruction and others serious illnesses intra-abdominal area.

Epidural anesthesia has much more relative contraindications. These include:

overweight;
unsatisfactory general state body;
pathological chronic diseases spine;
early age of the patient;
neurological diseases;
severe hypotension, etc.

The quality of the epidural anesthesia performed depends on the existing pathologies, the general health of the patient, the qualifications of the anesthesiologist and the drug used. Complications after successful completion of this manipulation are observed quite rarely: in one case out of twenty-two thousand, according to medical statistics. But the result of anesthesia does not satisfy the patient much more often: in one case out of twenty.

It is one of the most common and popular types of regional anesthesia (covers a limited area of the body) used in medical practice. The term "epidural anesthesia" is made up of the word "anesthesia", which means loss of sensation, and "epidural" characterizes into which space the anesthetic (the drug used to relieve pain) is injected. Held on different levels spinal cord, depending on the type of operation (obstetrics and gynecology, thoracic or abdominal surgery, urology), it is applied to which part of the body needs to be anesthetized. In obstetrics, epidural anesthesia is used at the level of the lumbar spinal cord.

In 1901, for the first time, epidural anesthesia was performed in the sacral region, with the introduction of the drug Cocaine. And only in 1921, it was possible to perform epidural anesthesia in the lumbar region. Since then, this type of regional anesthesia has been used in urology, thoracic and abdominal surgery. After 1980, epidural anesthesia was in demand and popularity, it began to be widely used during childbirth, thus giving birth to a new medical direction"Obstetric anesthesiology".

Epidural anesthesia is widely used in obstetrics: as anesthesia during cesarean section, or pain relief during natural childbirth. Until recently, caesarean sections were performed under general anesthesia. The transition from general anesthesia to epidural anesthesia during cesarean section made it possible to reduce the risk of possible complications during surgery: hypoxia (lack of oxygen) of the fetus, maternal hypoxia (several attempts at intubation, with unsuccessful intubation, in women in labor with anatomical features airways), blood loss, toxic effects of drugs on the fetus and others. The most important advantage of epidural anesthesia during a cesarean section, over general anesthesia, is the preservation of the mother’s consciousness in order to hear the first cry of her baby. But it should be remembered that not in all cases, the use of epidural anesthesia is possible.

The structure of the spinal cord, its functions

The spinal cord is an organ located in the canal spinal column. The spinal column is made up of vertebrae attached to each other by ligaments and joints. Each vertebra has a hole, so the vertebrae folded parallel to each other form a canal from the holes, where the spinal cord is located. Only up to the lumbar region the spinal cord fills the canal, then it continues in the form of a spinal filament, called the “cauda equina.” The spinal cord consists of 2 substances: outside - Gray matter(as nerve cells), inside - white matter. The anterior and posterior roots (axons or processes of nerve cells) emerge from the spinal cord, which participate in the conduction and reflex functions of the spinal cord. The anterior and posterior roots form spinal nerves(left and right). Each pair of spinal nerves has its own section of the spinal cord, which regulates a certain part body (this is important in the mechanism of epidural anesthesia).

The spinal cord is covered, first by the so-called soft membrane, then by the web, and then by the dura mater. Between the arachnoid and pia mater a space is formed filled with cerebrospinal fluid, which plays the role of shock absorption. The dura mater and arachnoid form protrusions (dural couplings, radicular pockets), they are necessary to protect the nerve roots during the movement of the spine. Above the dura mater in front and the ligamentum flavum in the back, the epidural space is formed, into which the anesthetic is injected during epidural anesthesia. The epidural space contains: fatty tissue, spinal nerves and vessels supplying the spinal cord.
The main functions of the spinal cord are:

reflex function- with the help of reflex arcs that pass through the spinal cord, muscle contraction occurs, they, in turn, participate in the movement of the body, and also participate in the regulation of the work of certain internal organs;
conductor function - conveys nerve impulses from the receptor (special cell or nerve ending) to the central nervous system(to the brain), there they are processed and the signal back again passes through the spinal cord to the organs or muscles.

Mechanism of action of epidural anesthesia

When an anesthetic (a drug that provides pain relief) is injected into the epidural space, it penetrates into the subarachnoid space through the dural couplings (radicular pockets), blocking nerve impulses passing along the spinal roots. Thus, there is a loss of sensitivity (including pain) with muscle relaxation. Loss of sensitivity in a certain area of the body depends on the level at which the nerve roots are blocked, i.e. on the level of epidural anesthesia. In obstetrics (caesarean section), pain relief is performed in the lumbar spine. Epidural anesthesia can be performed in 2 ways:

in the form of long-term anesthesia: repeated injection of small doses of anesthetic into the epidural space, through a catheter, this type of anesthesia is used during natural childbirth or for postoperative pain relief;
or a single injection of anesthetic into large doses, without the use of a catheter. This type of anesthesia is used for caesarean section.

Stages of epidural anesthesia

Preparing the patient (mother in labor): psychological preparation, warn that on the day of surgery, the patient does not eat or drink anything (if elective surgery), give her a sedative to drink, find out what drugs she is allergic to;
Examine the patient:

measuring body temperature, blood pressure, pulse;
do a general blood test (red blood cells, hemoglobin, leukocytes, platelets), blood group and Rh factor, coagulogram (fibrinogen, prothrombin);

Carrying out epidural anesthesia:

Preparing the patient: puncture of a peripheral vein with insertion of a catheter, connect to the infusion system, install a cuff for measuring pressure, a pulse oximeter, an oxygen mask;

Preparation of the necessary instruments: swabs with alcohol, anesthetic (lidocaine is often used), saline, a special needle with a guide for puncture, a syringe (5 ml), a catheter (if necessary), an adhesive plaster;
correct position of the patient: sitting or lying on the side with a maximum tilt of the head);

Definition the required level the spinal column, where it will be, epidural anesthesia is performed;
Treatment (disinfection) of the skin area at the level of which epidural anesthesia will be performed;
Puncture of the epidural space with the administration of the drug Lidocaine;

Monitoring of hemodynamics (pressure, pulse) and respiratory system.

Indications for the use of epidural anesthesia in obstetrics

Caesarean section (planned: in case of multiple pregnancy, other history of cesarean section; or emergency: sudden deterioration in the condition of the mother or fetus, premature birth);
High threshold pain during childbirth;
Pregnancy accompanied chronic hypoxia(lack of oxygen) fetus;
Sudden change in fetal heartbeat;
Heavy somatic diseases in a woman in labor ( diabetes, hypertonic disease, bronchial asthma, and others);
Malposition;
Anomaly of labor.

Contraindications for epidural anesthesia

Purulent or inflammatory diseases areas where it is necessary to puncture for epidural anesthesia (can lead to the spread of infection during puncture);
Infectious diseases (acute or exacerbation of chronic);
Lack of necessary instruments (for example: apparatus for artificial ventilation lungs) with the development of possible complications;
Changes in test results: clotting abnormalities or low platelets (may lead to heavy bleeding), high white blood cells and others;
If the woman in labor refuses this manipulation;
Anomalies or pathology of the spine (osteochondrosis with severe pain, herniated disc);
Low blood pressure (if 100/60 mmHg or lower), as epidural anesthesia lowers the blood pressure even further;

Benefits of epidural anesthesia during childbirth (caesarean section)

The woman in labor is conscious in order to receive pleasure at the first cry of her baby;
Provides relative cardio stability vascular system, in contrast to general anesthesia, in which during the induction of anesthesia or at a low dose of anesthetic, the pressure and pulse increase;
Can be used in some cases when full stomach, general anesthesia do not use with a full stomach, as there may be reflux of gastric contents into the respiratory system;
Doesn't irritate Airways(in general they are irritated by the endotracheal tube);
The drugs used do not have any effect toxic influence on the fetus, since the anesthetic does not enter the blood;
Does not develop hypoxia (lack of oxygen) of the woman in labor, including the fetus, unlike general anesthesia, during which hypoxia can develop as a result of repeated intubation, incorrect adjustment of the machine for artificial ventilation of the lungs;
Long-term anesthesia: first, epidural anesthesia can be used to relieve pain during childbirth, in case of complicated labor, with an increase in the dose of anesthetic, a caesarean section can be performed;
In surgery, epidural anesthesia is used against postoperative pain (by injecting an anesthetic into the epidural space through a catheter).

Disadvantages of epidural anesthesia during childbirth

Possible erroneous administration of the drug (in a large dose) into a vessel has a toxic effect on the brain, which can subsequently lead to sharp decline blood pressure, development of seizures, respiratory depression;
Erroneous injection of an anesthetic into the subarachnoid space, in small doses does not matter, in large doses (long-term epidural anesthesia with the introduction of a catheter), cardiac and respiratory arrest may develop;
To perform epidural anesthesia, a high level of medical training specialist (anesthesiologist);
Long interval between the administration of the anesthetic and the start of the operation (approximately 10-20 minutes);
In 15-17% of cases, there is insufficient (not complete) anesthesia, resulting in discomfort for the patient and the surgeon during surgery, so it is necessary additional administration drugs into a peripheral vein;
Possible development neurological complications, as a result of trauma to the spinal root with a needle or catheter.

Consequences and complications of epidural anesthesia

The feeling of pins and needles, tingling, numbness and heaviness in the legs, which develops after the introduction of an anesthetic into the epidural space, is the result of the action anesthetic drug on spinal roots. This feeling disappears after the drug wears off;
Tremors often develop a few minutes after the anesthetic is injected into the epidural space; this is normal. safe reaction, which itself passes;
Reduction (relief) of pain when using epidural anesthesia during physiological birth;
Inflammatory processes at the injection site, with antiseptics (sterility); in such cases, local use of ointments or solutions (antibiotics) is possible;
An allergic reaction to a drug requires stopping the administration of the drug that caused the allergy and introducing antiallergic drugs (Suprastin, Dexamethasone and others);
Nausea or vomiting develops as a result of a sharp drop in blood pressure. When the doctor corrects the pressure, these symptoms disappear;
A drop in blood pressure and pulse in a woman in labor, therefore, when performing epidural anesthesia, solutions for infusion or cardiotonics (Epinephrine, Mezaton or others) must be prepared;
Post-puncture headache, develops due to erroneous puncture of the hard tissue meninges, therefore, it is recommended to take a horizontal position for a day, and only on the second day can you get out of bed. This is explained by the fact that in horizontal position, the pressure in the spinal cord canal increases, which leads to the leakage of cerebrospinal fluid through the punctured canal, and this in turn leads to the development of headaches. It is also necessary to use anesthetics to reduce pain (Analgin or other drugs).
Acute systemic intoxication develops as a result of erroneous injection of an anesthetic (in large doses) into a vessel, so the doctor, when administering an anesthetic, must be sure that the needle is in the epidural space (check using aspiration, using a test dose);
Pain in the back, due to trauma to the spinal root, or at the puncture site.

What happens after an epidural?

Once a dose of anesthetic is injected into the epidural space, shutdown of nerve function and numbness should occur within a few minutes. Usually the action begins within 10-20 minutes. As the effect of the anesthetic wears off, the doctor administers new doses as needed, usually every 1-2 hours.

Depending on the dose of anesthetic administered, the doctor may prohibit you from getting out of bed and moving around for some time after the operation. If there are no other contraindications associated with the operation, it is usually allowed to stand up as soon as the patient feels that sensation and movement in the legs have been restored.

If epidural anesthesia is continued for a long time, bladder catheterization may be required. Due to the disconnection of innervation, independent urination becomes difficult. When the anesthetic wears off, the doctor removes the catheter.

How much does epidural anesthesia cost?

The cost of the procedure may vary depending on the city and clinic in which it is performed. If epidural anesthesia is performed in accordance with medical indications, it is free. If there are no indications, but the woman herself decides to give birth with epidural anesthesia, then its cost on average will be 3000-7000 rubles.

What is the difference between spinal and epidural anesthesia and epidural anesthesia?

The words “epidural” and “epidural” are synonyms. This is the same type of anesthesia.

Spinal, or spinal anesthesia- a procedure during which an anesthetic is injected into the subarachnoid space, located, as its name suggests, under the arachnoid membrane of the spinal cord. The indications for it are almost the same as for epidural anesthesia: cesarean section, operations on the pelvic and abdominal organs below the navel, urological and gynecological operations, operations on the perineum and lower extremities.

Sometimes a combination of spinal and epidural anesthesia is used. This combination allows:

reduce the dose of anesthetics administered into the epidural and subarachnoid space;
enhance the advantages of spinal and epidural anesthesia and eliminate the disadvantages;
enhance pain relief during and after surgery.

A combination of spinal and epidural anesthesia is used during cesarean section, operations on joints, and intestines.

Can an epidural affect a baby?

At the moment, many studies have been conducted to study the effect of epidural anesthesia on a child, and their results are ambiguous. During this type of anesthesia, there are factors that can affect the child’s body. It is impossible to predict how strong this influence will be in each specific case. It mainly depends on three factors:

dose of anesthetic;
duration of labor;
characteristics of the child’s body.

Since they are often used different drugs and their dosages, there are no exact data on the effect of epidural anesthesia on a child.

It is known that epidural anesthesia can lead to problems with breastfeeding. Another negative consequence is that during natural childbirth under epidural anesthesia, the child becomes lethargic, which makes it difficult for him to be born.

What is caudal anesthesia?

Caudal anesthesia- a type of epidural anesthesia in which an anesthetic solution is injected into the sacral canal, located in the lower part of the sacrum. It is formed as a result of non-fusion of the arches of the fourth and fifth sacral vertebrae. At this point, the doctor may insert a needle into end part epidural space.

The first epidural anesthesia in history was caudal.

Indications for caudal anesthesia:

operations in the perineal area, rectum and anus;
anesthesia in obstetrics;
plastic surgery in gynecology;
Pediatric epidurals: Caudal anesthesia is best for children;
sciatica- lumbosacral radiculitis;
surgical interventions on the abdominal and pelvic organs located below the navel.

With caudal anesthesia, the drug entering the epidural space disables sensitivity, and it can cover a different number of segments of the spinal cord, depending on the amount of the drug injected.

Advantages and disadvantages of caudal anesthesia:

Advantages

Flaws

Relaxation of muscles in the perineum and anus. This helps the surgeon during proctological operations.
Lower risk of low blood pressure.
The possibility of using this type of anesthesia in outpatient setting- the patient does not need to be hospitalized.

Higher risk of infection.
More complex execution due to large differences in the structure of the sacral foramen in different people.
It's not always possible to predict top level anesthesia.
There is a risk of poisoning from the anesthetic if a large amount has to be administered.
If you need to block the lumbar roots, you have to inject more large quantity anesthetic.
It is impossible to perform operations on the abdominal organs due to insufficient nerve block.
Loss of sensation occurs more slowly than with epidural anesthesia.
During caudal anesthesia, a complete block of the anal muscle sphincter occurs - during some operations this interferes.

Is epidural anesthesia used in children?

In children, epidural anesthesia has been used for a long time, as it has a number of advantages. For example, this type of anesthesia is used in infants during circumcision and hernia repair. It is often used in premature, weakened children who do not tolerate general anesthesia well, have high risks complications from the lungs. But the child’s body has some characteristics that affect the technique of the procedure:

If the child remains conscious during the operation, then he experiences fear. It is often impossible, like an adult, to persuade him to lie still. Therefore, epidural anesthesia in children is often performed in combination with light anesthesia.
Doses of anesthetics for children differ from doses for adults. They are calculated using special formulas, depending on age and body weight.
In children under 2-3 years old and weighing less than 10 kg, caudal anesthesia is used.
In children, the lower end of the spinal cord is located lower in relation to the spinal column than in an adult. The fabrics are more delicate and soft. Therefore, epidural anesthesia must be performed with extreme caution.
In children younger age The sacrum, unlike adults, is not yet a single bone. It consists of individual unfused vertebrae. Therefore, in children, an epidural needle can be passed between the sacral vertebrae.

For what other operations can epidural anesthesia be used?

In addition to obstetrics, epidural anesthesia is widely used in surgery.

Epidural anesthesia may be used:

In combination with general anesthesia. This allows you to reduce the dose of narcotic painkillers that the patient will need in the future.
As the only independent method pain relief, as during a caesarean section.
As a means to combat pain, including post-operative pain.

Operations for which epidural anesthesia can be used:

Operations on the abdominal organs, especially those located below the navel:
- appendectomy(surgery for acute appendicitis);
- operations in gynecology, for example, hysterectomy- uterus removal ;
- hernia repair for hernias of the anterior abdominal wall;
- bladder surgery;
- prostate surgery;
- direct and sigmoid colon;
- sometimes they even perform it under epidural anesthesia hemicolectomy- removal of part of the colon.
Operations on the organs of the upper abdominal cavity (for example, on the stomach). In this case, epidural anesthesia can only be used in combination with general anesthesia, as discomfort or hiccups may occur due to the fact that the blockage is not blocked. diaphragmatic, wandering nerve.
Operations in the perineal area (the space between the anus and the external genitalia). Epidural anesthesia is especially often used during surgery on the rectum. It helps to relax the anal muscle sphincter and reduce blood loss.
Urological operations, including on the kidneys. Epidural anesthesia is primarily used in older people for whom general anesthesia is contraindicated. But when operating on the kidneys under this type of anesthesia, the surgeon must be careful: there is a risk of opening pleural cavity, which contains the lungs.
Operations in vascular surgery, for example, with an aortic aneurysm.
Operations on blood vessels, joints, leg bones. For example, hip replacement can be performed under epidural anesthesia.

Using an epidural to control pain:

Pain relief in the postoperative period. Most often it is performed when the operation was performed under epidural anesthesia or in its combination with general anesthesia. By leaving the catheter in the epidural space, the doctor can provide pain relief for several days.
Pain after severe injury.
Back pain (ischiolumbalgia, lumbodynia).
Some chronic pain . For example, phantom pain after removal of a limb, joint pain.
Pain in cancer patients. In this case, epidural anesthesia is used as a method palliative(alleviating the condition, but not leading to a cure) therapy.

Is epidural anesthesia performed for a herniated disc?

Epidural blockade can be used for pathologies of the spine and spinal roots accompanied by pain. Indications for blockade:

radiculitis;
protrusion intervertebral disc or formed intervertebral hernia;
narrowing of the spinal canal.

Epidural anesthesia is performed in cases where pain does not go away for 2 months or more, despite the therapy, and there are no indications for surgery.

Epidural administration of steroids (drugs of adrenal hormones, - glucocorticoids, - which have a pronounced anti-inflammatory and analgesic effect) in conditions such as radiculopathy, radicular syndromes , intervertebral hernia, osteochondrosis, spinal stenosis.

Often the anesthetic and glucocorticosteroids.

Is epidural anesthesia included in the birth certificate?

It depends on the circumstances.

If epidural anesthesia is performed according to indications, it is included in birth certificate. In this case this type medical care is provided free of charge.

But epidural anesthesia can also be performed at the request of the woman herself. In this case it is additional paid service which will have to be paid in full.

Is epidural anesthesia used during laparoscopy?

Epidural anesthesia is performed during laparoscopic surgical interventions, including in gynecology. But it can only be used for short-term procedures and those that are performed on an outpatient basis (without hospitalization). Disadvantages of epidural anesthesia during laparoscopic operations:

Higher risk of oxygen deprivation due to increased blood levels carbon dioxide.
Irritation phrenic nerve, whose functions are not disabled during epidural anesthesia.
The possibility of aspiration is the entry of saliva, mucus and stomach contents into the respiratory tract as a result of increased pressure in the abdominal cavity.
With epidural anesthesia, it is often necessary to prescribe strong sedatives, which can suppress breathing - this further increases oxygen starvation.
Higher risk of cardiovascular system dysfunction.

In this regard, epidural anesthesia is limited use during laparoscopic operations.

What drugs are used for epidural anesthesia?

Drug name	Description
Novocaine	Currently, it is practically not used for epidural anesthesia. It begins to act slowly, the effect does not last long.
Trimekain	It acts quickly (numbness begins after 10-15 minutes), but not for long (the effect stops after 45-60 minutes). Most often used for epidural anesthesia through a catheter or in combination with other anesthetics.
Chloroprocaine	Just like trimecaine, it acts quickly (numbness begins after 10-15 minutes), but not for long (the effect stops after 45-60 minutes). It is used for short-term and outpatient interventions, as well as for epidural anesthesia through a catheter (in this case it is administered every 40 minutes).
Lidocaine	It begins to act quickly (10-15 minutes after administration), but the effect lasts quite a long time (1-1.5 hours). Can be administered through a needle or through a catheter (every 1.25-1.5 hours).
Mepivacaine	Just like lidocaine, it begins to act in 10-15 minutes and ends in 1-1.5 hours. It can be given through a needle or through a catheter, but this drug is not recommended for long-term pain relief during labor because it enters the bloodstream of the mother and baby.
Prilocaine	The speed and duration of action are the same as lidocaine and mepivacaine. This drug is not used for long-term pain relief and in obstetrics, as it negatively affects the hemoglobin of the mother and fetus.
Dicaine	It begins to act slowly - 20-30 minutes after administration, but the effect lasts up to three hours. This is enough for many operations. But it is important not to exceed the dose of the anesthetic, as otherwise its toxic effects may occur.
Etidocaine	It begins to act quickly - after 10-15 minutes. The effect can last up to 6 hours. This drug is not used in obstetrics, as it causes severe muscle relaxation.
Bupivacaine	It begins to act in 15-20 minutes, the effect lasts up to 5 hours. In low doses, it is often used to relieve pain during labor. This anesthetic is convenient because it acts for a long time and does not lead to muscle relaxation, so it does not interfere with labor. But with an overdose or injection into a vessel, persistent toxic effects develop.

What medications can affect epidural anesthesia?

Taking medications that reduce blood clotting is a relative contraindication to epidural anesthesia. A certain amount of time must pass between taking the medication and the procedure for its effects to wear off.

Drug name	*What should you do if you are taking this drug?**	What tests need to be done before epidural anesthesia?
Plavix (Clopidogrel)	Stop taking 1 week before anesthesia.
Tiklid (Ticlopidine)	Stop taking 2 weeks before anesthesia.
Unfractionated heparin(solution for subcutaneous administration)	Conduct epidural anesthesia no earlier than 4 hours after the last injection.	If heparin treatment lasted more than 4 days, it is necessary to take general analysis blood and check the platelet count.
Unfractionated heparin(solution for intravenous administration)	Conduct epidural anesthesia no earlier than 4 hours after the last injection. Remove the catheter 4 hours after the last insertion.	Definition prothrombin time.
Coumadin (Warfarin)	Conduct epidural anesthesia no earlier than 4-5 days after discontinuation of the drug.	Before administering anesthesia and before removing the catheter: definition prothrombin time; definition international normalized relations(blood clotting indicator).
Fraxiparine, Nadroparin, Enoxaparin, Clexane, Dalteparin, Fragmin,Bemiparin, Cibor.	Do not enter: in a prophylactic dose - 12 hours before the procedure; in a therapeutic dose - 24 hours before the procedure; after surgery or catheter removal - within 2 hours.
Fondaparinux (Pentasaccharide, Arixtra)	Do not administer within 36 hours before anesthesia; do not administer within 12 hours after completion of surgery or catheter removal.
Rivaroxaban	Epidural anesthesia can be performed no earlier than 18 hours after last dose; administer the drug no earlier than 6 hours after completion of the operation or removal of the catheter.

*If you are taking one of these drugs, be sure to tell your doctor. Do not stop taking it yourself.

The term "epidural anesthesia" is used in medicine to refer to one of the types local anesthesia.
The body has a dura mater that envelops the spine and cervical nerve endings. The epidural is the area surrounding this membrane and running along the spinal column.

Since the epidural area contains a large number of nerve endings, if they become inflamed, a person may experience severe pain in the epidural area. Inflammation can occur due to damage to the spinal discs and bone tissue spine.

This is when a situation arises when epidural anesthesia is necessary. There are many situations in which the use of epidural anesthesia is justified.

Epidural anesthesia.

From the examples below you can learn when and how epidural anesthesia is performed.

Firstly, these are gynecological operations, vascular and orthopedic interventions.

This type of anesthesia can also be used for postoperative pain relief. In this case, the drug is administered over several days, and the patient is given the opportunity to control the amount of the drug administered.

Injections of analgesics and steroids are given into the epidural area for pain relief lumbar pain.

Epidural anesthesia can be used in conjunction with general anesthesia. It can be administered in higher doses and replace general anesthesia (for caesarean section).

This type of anesthesia is most indicated for pain relief during operations on the abdominal cavity and during operations on the legs. It is not very suitable for operations on the chest, arms and neck and is not used at all for neurosurgical operations.

Most frequent cases, when epidural anesthesia is needed, are pain relief during childbirth. In most cases, this anesthesia immediately relieves the pain. It is suitable for normal vaginal delivery, vacuum extraction, vaginal birth with the application of forceps. This type of anesthesia allows the woman in labor to monitor what is happening, remaining conscious throughout the birth.

It is worth saying that the perception of epidural anesthesia is individual for each person. The degree of pain relief varies from case to case.

For epidural anesthesia, special, preservative-free, highly purified solutions are used. This may include lidocaine, ropivacaine or bupivacaine. To enhance the effect of these anesthetics, so-called opiates are often added to the solution, most often fentanyl, buprenorphine, morphine, fentanyl. The dose of opiates in this case is significantly less than with intramuscular or intravenous administration, and the duration of anesthesia and its quality are better.

With epidural administration, patients are much less likely to experience symptoms characteristic of taking opiates, such as vomiting, nausea, dizziness, respiratory depression, etc. For example, 5 g of morphine administered intravenously can anesthetize postoperative wounds for up to 6 hours, and administration of 1 g of morphine epidurally provides persistent pain relief for 18-24 hours.

Clonidine and ketamine are also often added to the epidural solution. The doses of these drugs are also significantly reduced compared to intravenous administration, which avoids the development side effects– lowering blood pressure and anxiety states.

How is epidural anesthesia done??

First, the surgeon injects a local anesthetic into the lower section backs. A hollow needle is then inserted into the space between the vertebrae. When inserted correctly, the needle is positioned between the dura mater of the spinal cord and the periosteum of the vertebrae. This area is called the epidural. A catheter is then inserted through the hollow needle. Injected through a catheter medications.

There are several ways to administer epidural pain medications:

1. Pain relief with increasing dose. The anesthesiologist administers a mixture of painkillers until the patient's abdomen no longer feels pain. As the effect of pain relief weakens, additional doses of drugs may be administered.

2. Continuous administration. After installing the catheter, its end is connected to a pump, from which an anesthetic solution will constantly flow. Patients can usually operate this pump themselves if pain occurs. This anesthesia is called patient-controlled epidural anesthesia.

3. Combined epidural anesthesia. After giving the patient a small dose of painkillers, the doctor inserts a catheter. When the effect of the first anesthetic injection wears off, the anesthesiologist will inject an anesthetic solution through the catheter.

In addition to the question of how and how anesthesia is done, it is worth considering the question of whether epidural anesthesia has disadvantages.

Disadvantages of anesthesia:

1. First of all, the main disadvantage of this type of anesthesia is the insufficient effect of anesthesia in some patients.

2. Disadvantages also include the feeling of chills that occurs in patients and the use of a catheter to empty the bladder.

3. If epidural anesthesia occurs during childbirth, the risk of using a vacuum extractor or forceps for delivery increases.

4. It is possible that you may experience a headache or a feeling of numbness in your legs if any nerve was hit when inserting a needle into the spine.

Despite all the shortcomings, epidural anesthesia is considered a more effective method of pain relief for people who are not indicated for general anesthesia(for example, with high blood pressure). It is worth saying that when epidural anesthesia is used, it not only has an analgesic effect, but also lowers blood pressure.

Although epidural anesthesia has recently become widespread for some types of surgical intervention, many patients do not immediately decide to use this type of anesthesia. Qualified consultation with a doctor on how and when epidural anesthesia is performed, how it works, what the advantages and disadvantages of epidural anesthesia are, will help patients make the right choice.

Today, almost every maternity hospital offers pregnant women epidural anesthesia during childbirth. She injects a woman in labor in the back at a certain stage birth process, relieves pain and alleviates the condition expectant mother. However, this procedure may not be suitable for everyone. There is a certain category of women for whom spinal anesthesia is contraindicated. In this article we will talk in detail about what epidural anesthesia is, how it is performed and why it is dangerous.

Epidural anesthesia is a type of local anesthesia. It relieves pain from contractions, which are sometimes simply unbearable for a woman.

Anesthesia is administered into lumbar region spine, where the epidural space is located. It contains the spinal roots of the nerve endings of the pelvic organs, which include the uterus. Anesthesia blocks pain, and a woman can a long period don't feel any contractions at all unpleasant symptoms. In this matter, you need to choose the right dosage for the woman in labor so that she does not feel painful contractions, but at the same time can walk independently and be conscious. By the way, today epidural anesthesia is widely used for caesarean section, which allows mothers to see the birth of their child, even if she cannot give birth naturally.

It should be noted that when natural childbirth The effect of epidural anesthesia lasts only during contractions, when the cervix dilates so that the baby can pass through birth canal. The woman is forced to endure the pushing without pain relief, but it does not last long, so it can be tolerated.

If a woman needs to use epidural anesthesia strictly according to medical indications, then it is administered to her free of charge, but if she simply expresses a desire to give birth under anesthesia, then she will have to pay for it separately.

How is epidural anesthesia given?

The technique of epidural anesthesia is quite complex, although the administration process takes spinal anesthesia just 10 minutes. It requires a highly qualified anesthesiologist and adherence to strict rules:

A pregnant woman should bare her back, sit down, or lie on her side so that the doctor has access to the puncture site. It is very important to freeze in the chosen position, because unnecessary body movements can lead to many complications.
The doctor treats the area that will be pierced with a special antiseptic.
After this, the anesthesiologist numbs the area that will be pierced. For this, banal Lidocoin is used.
After this it is used special set for epidural anesthesia - a special needle with anesthesia is inserted (it will take effect 20 minutes after administration). It must reach the dura mater. A special tube is inserted into the needle - a catheter, which will be in the back of the woman in labor until she pushes. Just keep in mind that anesthesia cannot be administered at the moment of contraction. If you feel that a contraction is approaching, then tell your doctor, because during the moment of spasm you can move, and this will lead to detrimental consequences.
After childbirth, the catheter is removed from the woman's back, but for 2-3 hours after epidural anesthesia, the doctor will recommend that the woman in labor remain motionless.

Epidural anesthesia during childbirth can be administered to a woman in two ways:

Gradually, introducing small doses.
Once, administering the entire dose of the drug at once. With this method, the woman cannot get up, because the components of anesthesia will dilate the blood vessels in the legs, and the woman in labor will simply not be able to walk.

Epidural anesthesia is absolutely safe for the child. Painkillers do not enter his blood, so the placenta does not absorb them.

Indications for epidural anesthesia in the maternity hospital

Western medicine practices epidural anesthesia all the time. Women, as soon as she comes to make arrangements for childbirth, are immediately offered to use local anesthesia. Domestic medicine recommends use spinal anesthesia only for strict medical reasons:

If a woman goes into premature labor. Premature baby with a relaxed cervix under the influence of anesthesia, it will be easier to pass through the birth canal.
If labor activity the woman is so weak that she has contractions but does not dilate.
If a woman in labor has too high blood pressure, at which the woman cannot give birth herself. Epidual anesthesia, according to reviews, perfectly reduces blood pressure.
If a woman multiple pregnancy or her baby is too large, as a result of which she cannot give birth on her own, and general anesthesia is contraindicated; spinal anesthesia is suggested.
If labor is prolonged and the pregnant woman can no longer endure labor pains, then she is given anesthesia.

Contraindications to epidural anesthesia

vegetative-vascular dystonia in a pregnant woman;
deformed spine, which complicates the puncture process;
there are rashes on the skin in the area where the puncture will be performed;
blood problems ( poor clotting, infection);
bleeding;
individual intolerance to anesthesia components;
the woman is unconscious;
heart or vascular diseases;
Epidural anesthesia is not given for lumbar spinal hernia.

Complications of epidural anesthesia

After epidural anesthesia, a woman may experience some complications:

The doctor may accidentally enter the venous bed of the spine, and then the woman will begin to have headaches after the administration of epidural anesthesia, she will feel nauseous, and her tongue will become numb.
Anaphylactic shock may occur (this occurs if the woman does not know that she has an allergy).
Quite rarely, a consequence of epidural anesthesia such as difficulty breathing occurs.
In addition, women in labor often complain of back pain after epidural anesthesia. Your back may hurt for several days after giving birth. If the pain does not stop after epidural anesthesia, then doctors must make a puncture again in the place where the anesthesia was administered in order to inject the woman’s blood there, which will seal the puncture site.
After epidural anesthesia, legs may be paralyzed, but this only happens if the technology for administering anesthesia was carried out incorrectly.
After giving birth with an epidural, a woman may have difficulty urinating.

To avoid negative consequences After an epidural, you need to weigh the pros and cons of the procedure. We will tell you more about this later.

Epidural anesthesia: pros and cons

The main advantages of spinal anesthesia during childbirth include:

the ability to make childbirth painless and comfortable;
if labor is delayed, the woman can even sleep after epidural anesthesia;
women in labor with high blood pressure With the help of spinal anesthesia, they can not be afraid to give birth on their own.

The main disadvantages of epidural anesthesia:

some complications may arise due to the incompetence of the doctor or the sudden movement of the woman during the puncture;
the mother may lose the psycho-emotional connection with the child, although this fact has not been proven.

Your main task is to listen carefully to the doctor about what to do after epidural anesthesia. Following your doctor's recommendations will help prevent possible complications and ensure proper recovery after spinal anesthesia.