One of the most common concerns of pregnant women before delivery is whether to apply an epidural. Everything about the procedure and possible complications you can read in this article.
Application of epidural anesthesia in obstetrics is a common method. Today more and more pregnant women decide to give birth with epidural, although still a small percentage of women are afraid to opt for this method.
Epidural anesthesia is neuraxial technique that provides different possibilities of application of a local anesthetic. Epidural block can be performed in the cervical, thoracic and lumbar level. Techniques of epidural blockade are widely used: During surgery, painless childbirth, postoperative pain control, as well as in the therapy of chronic pain. The technique is based on the identification of the epidural space and the application of a local anesthetic in it, which results in blockage of sensory nerve.
The application of a local anesthetic is achieved via epidural catheter at one end in the epidural space, and the second (free end), through which is the application of anesthetics, is carried out on the left or to the right shoulder of the patient, so that the patient can freely lying on the back in bed. The application of a local anesthetic is different and involves a single dose of anesthetic at certain intervals or continuously giving anesthetic through the pump which ensures continuous analgesia (lack of pain).
How is epidural anesthesia performed?
The identification of the epidural space and application of the catheter can be performed in a sitting position or lateral position. The technique requires the presence of an experienced anesthetist and anesthetist who will help the patient to take the correct position to make the procedure as quickly as possible. The average time of placing the catheter is between 15 and 30 minutes, which depends on the cooperation of the patient, and the anatomy of the spinal column. The placement of the epidural catheter is not directly connected with the administration of the anesthetic. It is recommended that the catheter is placed earlier, while the patient feels comfortable and can take the appropriate position without difficulty.
When is epidural anesthesia given?
Giving an anesthetic is strictly connected with favorable obstetric findings that allows this intervention. Anesthesiologist in consultation with a gynecologist begins with giving of anesthetic. The course of the childbirth follows the obstetrician. It should be noted that labor with epidural means seamless cooperation anesthetist and gynecologist. With achievement of favorable obstetrics finding begins the epidural analgesia. Favorable obstetric finding implies the presence of contraction at 3 to 4 minutes that last up to one minute, the corresponding cervical dilation of 2 to 3 fingers, or 3 to 4 centimeters as well as spontaneous rupture of membranes or its rupture.
What are the most common complications?
Given the fact that the technique of epidural anesthesia is “blind” method, which means that it is not possible to visually monitor the position of the catheter in the epidural space, it carries a certain percentage of complications.
Hypotension, or low blood pressure
The most common complications after regional anesthesia is hypotension. It occurs due to decreased sympathetic tone and increased compression of the vena cava, which is especially pronounced in the pregnancy. The therapy is aggressive and involves the application of oxigen therapy, vasoactive drugs and fluid infusion.
Postepidural headache or post dural puncture headache
It occurs after accidental dural puncture with the needle during the performance of techniques epidural. The headache usually occurs 12 to 72 hours after performing the procedure and is characterized by occipital headache that is very apparent in the standing position, and stops in the supine position. The therapy involves the application of infusion solutions, lying on a flat surface, use of analgesics that contain caffeine. Symptoms of headache go for a few days and last up to a maximum of 7 days from the epidural procedure.
Less frequent complications
Less frequent complications involve retention of urine that ends after the effects of local anesthetics stops, pain that may last for several weeks after the execution procedures and the treatment is symptomatic and includes the use of analgesics, as well as allergic reactions to local anesthetics.
Once again it should be noted that delivery with the epidural technique comfort for both, the patient and the entire medical team, and that the highest percentage of women have positive experiences in connection with this type of anesthesia.
What women during delivery with epidural feels?
After ten to fifteen minutes of the first dose of anesthetic, mothers begin to relax and feels less pain. Today in maternity wards it recommends continuous anesthetic through the pump which achieves satisfactory pain control. Continuous analgesia via pump allows safe and painless procedures of the obstetrician after completing delivery, such as episiotomy, cervical stitching, or uterine revision.
When is not possible to give epidural anesthesia?
There are very rare situations when epidural analgesia is contraindicated during childbirth. These contraindications include: infection at the place where catheter is placed, the refusal of the patient for this type of intervention, coagulopathy, or other hematological diseases associated with prolonged bleeding, severe hypovolemia, increased intracranial pressure, stenosis aortic or mitral orifice, as well as allergy to local anesthetics. Relative contraindications are previous neurological deficit, injury or surgery of the spinal column. In patients who are on long-term low molecular weight heparin, placing a catheter should be delayed for 12-24 hours from the application last dose of the drug.
Does epidural reduces delivery time?
The advantage of the epidural is that the patient does not feel pain, and the other big advantage is shortening the duration of labor or the acceleration the phase of dilation (opening), thus shortening the time of childbirth. If delivery takes less time, trauma due to the passage of the baby through the birth canal is smaller, so that children born using epidural are much less tormented during childbirth.