Epidural anesthesia has been known to mankind for over a century, but it has received widespread use only recently. The method of reducing pain is especially widely used during childbirth, both natural and surgical. A lot is known about the advantages of anesthesia, but in this material we will talk not so much about them as about the possible consequences of such anesthesia. Is epidural anesthesia safe and harmless?
About the method of pain relief
Epidural anesthesia is a method of pain relief in which a drug that reduces sensitivity to pain is injected not into a muscle or a vein, but into the spine, more precisely, into its epidural space. A large number of nerve endings are observed in it. When a drug with an anesthetic effect enters this space, the nerve endings are blocked and stop sending impulses to the brain, including those about pain. This method is also called epidural, and it refers to regional anesthesia, which makes it possible to anesthetize certain parts of the body, and not the entire patient completely.
Anesthetic drugs are injected into the epidural space by means of a lumbar puncture. For pain relief during labor, medicinal solutions are injected into the space between the first and second vertebra of the lumbar spine, and during caesarean section, where anesthesia requires deeper and more prolonged, the anesthesiologist selects a space in the range from 2 to 5 of the lumbar vertebra.
If there is a need to anesthetize the stages of contractions in natural childbirth, then the dosage of drugs will be significantly lower than the dosage for surgical delivery. The exact doses are determined on a case-by-case basis - the taller a woman is, the more drug is required to block the segments of the spine.
The first "epidural" was carried out back in 1901, by injecting cocaine into the patient's sacral spine. And only 20 years later, doctors learned to anesthetize the lumbar and sternum.
Advantages and disadvantages
The undoubted advantages include the selectivity of the action of anesthesia - a woman maintains clarity of mind and consciousness, she can hear and see everything that is happening, as well as communicate with doctors. If a cesarean is done using such anesthesia, then in addition to the opportunity to hear the first cry of the baby, there is the possibility of early attachment of the baby to the breast, which has a positive effect on lactation.
During the operation, the cardiovascular system continues to work normally, there are no jumps in blood pressure. The upper respiratory tract is not irritated like a tube under general anesthesia.
The disadvantages of this method of pain relief must be treated very carefully. So, epidural pain relief:
- has contraindications;
- in terms of results, depends on the qualifications and accuracy of the doctor's actions - careless movements, erroneous actions can lead to serious consequences;
- has a long latency period - after the introduction of drugs into the epidural space of the spine, the desired effect does not occur immediately, but after 15–20 minutes;
- in about 17% of cases, regional anesthesia does not have the desired effect, it is insufficient or inadequate;
- after application has side effects - back pain, headaches.
Technique
The procedure requires special training and great precision from the anesthesiologist. After the treatment of the outer skin with an antiseptic, the woman is placed on her side, lying or sitting with her head and shoulders lowered (her back "arc"). The doctor inserts a thin special needle for lumbar puncture into the space between the vertebrae. Having overcome the ligaments, the needle enters the space, which is called the epidural.
After making sure that the hit is accurate (the needle enters freely and does not meet resistance), the doctor inserts a catheter and a test dose of the drug. After a few minutes, the woman's condition is assessed. Then the rest of the dose is administered.
If necessary, the doctor can add the drug at any time when needed, since the catheter remains in the spine.
Negative consequences
Peridural anesthesia is not as safe as it might seem at first glance. Penetration into the inner space of the spine has its own risks and can be associated with various complications.
So, in women with reduced blood clotting, the appearance of hematomas at the puncture site with subsequent penetration of blood into the cerebrospinal fluid is possible. When the procedure is performed by an experienced doctor, the likelihood of complications is low. But a not too qualified specialist with little experience can injure the hard spinal membranes, and this can threaten with leakage of cerebral fluid, a disorder of the functions of the central nervous system.
Another injury is not excluded - when the needle wounds the subarachnoid space of the spine, located slightly deeper than the epidural. In this case, the consequences can be more serious. In this case, a woman develops a convulsive syndrome, she loses consciousness, and serious violations of the central nervous system are recorded. In the most difficult cases, temporary or permanent paralysis of the lower limbs can occur.
Violation of the integrity of the epidural space during puncture often becomes the cause of prolonged headaches. The back hurts quite noticeably.
The claims that such pain relief does not affect the child are not true. The drugs penetrate into the blood, however, to a lesser extent, so children in the womb also receive their portion of the anesthetic, which can sometimes cause the development of respiratory failure, hypoxia and disturbances in the heart rate of the newborn after birth. It should be noted that there is no reliable and accurate data on how the "epidural" affects a child - this issue is still under study, there is little information to draw any conclusions.
The procedure itself causes fear and psychological discomfort. The hardest part is for those who have a planned cesarean section. In addition to the well-understood fears about the outcome of the operation, women are afraid of the process itself, because they will practically have to be present at their own surgical delivery, and this is quite difficult.
In addition, other complications are noted:
- the occurrence of severe tremors after the administration of the drug as a reaction of the nervous system;
- prolonged numbness of the extremities - passes over time;
- inflammation at the puncture site, infection in the spinal canal;
- an allergic reaction to an anesthetic drug;
- slowing down the production of breast milk (under the influence of drugs, lactation processes slow down, milk may appear later).
Recovery after epidural anesthesia is somewhat easier and faster, the anesthesia goes away more gently, without vomiting and nausea. This type of pain relief does not in any way affect the severity of rehabilitation after childbirth or caesarean section in general, does not reduce or increase the likelihood of complications.
The likelihood of complications and risk factors
With all the existing risks of developing negative consequences, epidural anesthesia is still considered quite safe. It's about statistics. It states that complications after using this method of pain reduction cause negative consequences only in one case in 50 thousand births.
Risk factors are considered to be the ignorance of the requirements for contraindications of epidural anesthesia by the medical staff, the inept actions of the anesthesiologist. The success of the application depends primarily on it, and only secondly on the modern equipment for epidural anesthesia in the maternity hospital, compliance with the requirements for processing and sterilization of instruments. Today, they try to use disposable sterile sets of needles, catheters, which also reduces the likelihood of infection.
It will be safer for the mother and child if she undergoes standard training before injecting the anesthetic into the epidural space of the spine, talks to the anesthesiologist so that none of the existing contraindications goes unnoticed.
Reviews
The vast majority of women who gave birth with epidural anesthesia or chose it for cesarean section were satisfied with the result and effect, but note that there were still side effects. This mainly concerns heaviness in the legs, numbness of the limbs, head and spinal pains, which sometimes drag on for several weeks after surgery or physiological childbirth with the use of "epidural".
Those who have experienced the effect of several types of anesthesia sometimes argue that they did not notice any special advantages of epidural anesthesia over general anesthesia. In addition, the recovery was not as easy as the preoperative anesthesiologists describe.
For the consequences of epidural anesthesia, see the following video.
