What is an Epidural

Want to learn more about an epidural and epidural anesthesia?

Epidural anesthesia is a type of anesthetic technique (as compared to general anesthesia).  Epidural anesthesia can be used by itself to provide anesthesia for some procedures (childbirth) or it can be combined with general anesthesia (for pain relief after some type of major surgery).  The epidural space surrounds the spinal cord and is in contact with the nerves that travel to and from the spinal cord. Medicines can be placed into the epidural space in the neck, upper back, and lower back. It all depends on the area that needs to be anesthetized. Epidural anesthesia is most frequently associated with women in labor, which is called a labor epidural.

You might be familiar with epidural anesthesia in situations other than in a pregnant woman. For instance, pain management physicians may place medicine into the epidural space of the neck to help relieve neck and arm pain. This is a cervical epidural steroid injection. Patients undergoing lung surgery or chest surgery sometimes have a thoracic (upper back) epidural placed for pain relief (analgesia) during and after surgery. If you undergo abdominal surgery, an epidural may be placed in the lower back or lumbar region to provide analgesia after surgery. Finally, caudal epidural anesthesia is often placed in babies and infants for pain relief after circumcision, hernia, and testicular surgery. The medicine is placed into the lowest portion of the epidural space near the lowest portion of the spine.

The basic point is that epidural anesthesia can be placed at multiple levels of the spine. There are many other examples of surgeries for which an anesthesiologist might place an epidural. Lung surgery, abdominal hysterectomy, colectomy, caesarean section, hip surgery, and knee surgery are a few other examples. All of these epidurals are performed by anesthesiologists who are trying to relieve or limit pain. In addition, pain management physicians may place epidural steroid injections at many different levels of the spine.

In addition to placing medicine at different locations in the epidural space, catheters are often placed with this technique to continuously infuse medicine. These catheters are tiny tubes, about the width of pencil lead, and stay in the epidural space until the catheter is removed by a physician or nurse. Patients cannot feel the catheter in their back or epidural space, but they might feel the tape securing the catheter to the skin as it exits the back. The end of the catheter tubing that is NOT in the epidural space is then connected to a pump. This pump contains the medicine that flows into the epidural space. Often that medicine is a local anesthetic (eg. lidocaine) which may be combined with an opioid (eg. morphine).

Epidural anesthesia is guided by anesthesiologists. Vital signs will be examined and pain relief will be assessed frequently. Your safety is of great concern when epidural anesthesia is in place. If there are any possible side effects from the medicine, the anesthesiologist on duty will be involved. Depending on the types and doses of medicines used, some possible side effects include: drops in blood pressure (hypotension), itching, and nausea/vomiting. We want you to be as comfortable as possible, but we are also very concerned with your safety. If you have an epidural in place, an anesthesiologist will be involved in its management to ensure the best possible outcome in providing pain relief, minimizing side effects, and ensuring your overall safety.

You can see that an “epidural” encompasses many different things. Really, the word epidural is used by patients and healthcare personnel to refer to epidural anesthesia. But usually, when asked, “What is an epidural?” the most likely answer is:

An epidural is the catheter that continuously delivers anesthetic medicine into the epidural space to provide pain relief.  Talk to your anesthesiologist on the day of surgery to learn more.  Check out the epidural video as well.