Epidural anesthesia is commonly known as the type of anesthesia used to alleviate pain associated with labor and delivery. Epidural anesthesia has also been used successfully, in conjunction with opioids, for coronary bypass grafting. It is a regional anesthesia that may be inserted through several locations on the back, unlike spinal anesthesia. The term epidural refers to the method doctors use to administer the anesthesia. Epidural anesthesia is given through a catheter.
Differences between Spinal and Epidural Anesthesia
Spinal and epidural anesthesia are similar in that they are both administered along the spine. They have multiple uses, and they are both beneficial for medical procedures located below the abdomen. Major risks tend to be associated with locations below the waist for this reason. Although regional anesthesia can be less risky than general anesthesia, patients and doctors should still discuss all health concerns and possible outcomes of the procedure.
Notable differences between spinal and epidural anesthesia include:
- Epidural anesthesia is administered through a catheter, while spinal anesthesia is injected through a needle.
- Spinal anesthesia sets in within 5 minutes. Epidural anesthesia takes about 15-30 minutes.
- Epidural anesthesia is typically used for a larger area of the body and requires a greater dose of medication, usually around 10-20 milliliters.
- Spinal anesthesia calls for a smaller dose of medication, about 1.5-3.5 milliliters.
- An indwelling catheter is more common for epidural anesthesia than for spinal. This allows for easier methods of adding anesthesia at a later time.
- Epidural anesthesia may be administered anywhere along the vertebral column, including cervical, thoracic, lumbar, or sacral. Spinal anesthesia may only be injected beneath the L2 lumbar vertebrae, to avoid puncturing the spinal cord.
Epidural Anesthesia Complications
Preexisting conditions may cause negative outcomes of epidural anesthesia. An anesthesiologist should discuss all current health conditions with the patient prior to selecting an epidural anesthesia. Any potential benefits and risks should be explained. The patient should fully understand the process and type of anesthetic drug that will be administered.
Conditions that may increase patient safety risk involve:
- Allergies related to the anesthetic
- Spinal abnormalities, such as spina bifida or scoliosis
- Previous spinal injury, which may have created scar tissue
- Low circulating blood volume
- Bleeding disorders
- Bloodstream infections
- Infection near intended catheter site
- Central nervous system disorders, such as syringomelia or multiple sclerosis
- Heart valve issues, such as aortic stenosis
Epidural Side Effects
A review conducted in 2011 randomly selected and assessed 9,658 women electing for epidural anesthesia. It involved a total of 38 controlled studies, of which 33 compared the use of epidural anesthetic drugs to the use of opiates. Pain relief was provided quickly and effectively through an epidural, without the need for naloxone to offset the use of opiates during birth.
There were many notable disadvantages to epidural anesthesia, such as:
- Longer delivery
- Greater need for oxytocin to encourage contractions
- More instruments needed to help with the birth
- Increased risk of dangerously low blood pressure
- Increased risk of emergency cesarean section
- Greater risk of fever
- Larger amount of fluid retention
- Partial anesthesia resulted in 15% of cases
- Failure to achieve any anesthesia in approximately 5% of cases
Maternal risks associated with epidural anesthesia after child birth included:
- Accidental dural puncture
- Increased chance of muscular weakness after birth
- Bloody catheter, as a result of a major vein puncture
- Neurological injuries
- Epidural abscess or hematoma formation
- Delayed start to breastfeeding, shorter breastfeeding times
Bjertnaes, Lars J., et al. “Epidural anesthesia and postoperative analgesia with ropivacaine and fentanyl in off-pump coronary artery bypass grafting: a randomized, controlled study.” BMC Anesthesiology 11 (2011): 17. Academic OneFile.Web. 19 June 2012.
“Breaches in epidural anesthesia aseptic technique.”AORN Journal Aug. 2008: 287+. Academic OneFile.Web. 19 June 2012.
Cohen, Amy, et al. “Maternal epidural use and neonatal sepsis evaluation in afebrile mothers.”Pediatrics Nov. 2001: 1099+. Academic OneFile.Web. 19 June 2012.
Johnson, Sigrid, and Jo Ann Rosenfeld.”The effect of epidural anesthesia on the length of labor.”Journal of Family Practice Mar. 1995: 244+. Academic OneFile.Web. 19 June 2012.
“Recognized complication of epidural anesthesia.”Clinician Reviews Mar. 2010: 14. Academic OneFile.Web. 19 June 2012.
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