An epidural is a procedure that delivers pain medications through a small tube in your back. Side effects are typically temporary, and severe complications rarely occur.
An epidural is commonly used during labor, delivery, surgery, and to treat spinal injuries.
An epidural is a procedure that involves administering one or more pain medications (anesthetics). Anesthetics cause a loss of feeling in the lower half of the body. An anesthesiologist, a doctor who specializes in pain management before, during, and after surgery, administers an epidural.
These medications are delivered through a small tube (catheter) placed in your back that opens into the space around your spinal nerves, or the epidural space. Anesthetics are given through the tube for as long as pain relief is needed.
The rates of epidural use during labor and delivery range from 36.6% to 80.1%, depending on the state you live in. The lowest rate is in Maine, while the highest is in Nevada. People also use epidurals during and after surgery or to treat back or leg pain.
There are several types of epidurals and ways to administer them. The type of epidural you receive depends on several factors.
Epidural Medication Delivery Options
There are different ways an anesthesiologist can administer medication using an epidural. These include:
- Catheter: This thin, flexible tube is inserted into the epidural space to continuously administer anesthetics. You might require a catheter if you require long-term pain management, such as for a lengthy procedure or labor and delivery.
- Patient-controlled analgesia (PCA): This device allows you to adjust the amount of anesthetics if you are recovering from surgery. A healthcare provider sets the dosage, and you’ll press a button to deliver the medication if you feel pain.
- Single-injection: A healthcare provider will inject anesthetics into the epidural space for short-term pain management.
Labor and Delivery Epidurals
A healthcare provider will typically use a catheter to administer anesthetics during labor and delivery. Some people may receive a combined spinal-epidural (CSE), which is an injection and a catheter. This method allows you some feeling in your lower body so that you can move around.
Epidural Steroid Injections (ESI)
An epidural steroid injection (ESI) delivers a combination of anesthetics and steroids into the epidural space. This type of epidural helps manage pain from spinal injuries. The effects can last days to years.
An anesthesiologist will administer an epidural through the epidural space in your lower back. This typically involves a single injection or a catheter. The catheter will remain in place for the duration of surgery or labor and delivery.
How To Prepare
Talk to an anesthesiologist if you have questions or concerns about an epidural. They will provide information on eating, drinking, and taking medications while on an epidural. It’s also important to make sure someone is available to drive you home since you won’t be able to drive for 24 hours after an epidural.
What To Expect During an Epidural
An anesthesiologist will administer an epidural, typically while you are sitting down and leaning forward. They will numb the area using a local anesthetic so it won’t hurt when an epidural is administered.
The anesthesiologist will then use a needle to insert a catheter. The anesthetics will flow through the catheter. The catheter will remain in place for as long as you need pain relief, which can last several hours if you are in labor.
Recovery
Your lower body will continue to feel numb for a few hours after the catheter is removed. A healthcare provider will likely instruct you to rest as you wait for the effects to wear off.
Epidurals are generally safe. There are side effects and risks, as with most procedures. Knowing these side effects and risks can help you decide whether an epidural is a good option for you.
Breathing Problems
Opioids sometimes cause slow breathing or other breathing problems. A healthcare provider will monitor you closely and intervene if you have difficulty breathing.
Fever
A 2020 study found that 11% to 33% of people who get an epidural during labor develop a fever, compared to 1% to 7% of those who do not get one. The longer the fever lasted, the higher the risk of complications, such as needing a surgical vaginal or cesarean (C-section) delivery.
It is unknown why fevers can occur during labor, especially with epidurals. The study authors suggested that an epidural induces an inflammatory response and may alter temperature regulation in the body.
Inadequate Pain Relief
An epidural may not block all your pain in some cases. A 2021 study found that the overall failure rate was about 15% among 500 women who received an epidural. A healthcare provider might offer you an additional or alternative pain relief method if an epidural doesn’t work.
Infection
There’s a small risk of infection when an opening is made in the skin, even by injection with a needle. However, it’s unlikely you’ll get an infection from an epidural. The needle is sterile, and your skin is cleaned before insertion.
Itching
Some of the medications used in an epidural, such as opioids, can make your skin itch. Why itching develops is not clear. Some evidence suggests that mast cells (a type of immune cell) release histamine when they’re activated. Histamine is a chemical that causes itching. Opioids trigger a similar response in the body.
A healthcare provider might change the medication you’re being given if the epidural causes itching. They can also give you another medication to relieve the itching.
Low Blood Pressure
Some people who choose an epidural during labor experience a decrease in blood pressure (hypotension). Epidurals affect the sympathetic nervous system, or a series of nerves that spread from your spine to your body. These nerves help control several involuntary bodily functions, including blood flow.
If you have an epidural, your healthcare provider will closely monitor your blood pressure. Fluids and medication can be administered through an IV to control blood pressure if necessary. Your healthcare provider may also recommend using compression on your legs to keep your blood pressure up.
Using a sequential compression device significantly reduces the rates of hypotension. This device is like a blood pressure cuff that goes around your legs. It alternates between providing compression on the legs and relaxing.
Nausea and Vomiting
A drop in blood pressure can sometimes make you feel lightheaded and nauseous. Some people are also more sensitive to opioids than others. The body may try to vomit in response to the drugs. Ask a healthcare provider if they can give you anything to help calm your stomach.
Nerve Damage
It’s very rare, but the needle used to deliver the epidural can hit a nerve. This can lead to temporary or permanent loss of feeling in your lower body. Be sure to alert a healthcare provider right away if you have numbness or tingling after the epidural is supposed to have worn off.
Severe Headache
An epidural can cause a severe headache if the needle accidentally punctures the membrane that covers the spinal cord and fluid leaks out, or a dural puncture. It isn’t very common, but the headache can often be treated with oral pain relievers and fluids.
A procedure known as a blood patch may be needed to seal the puncture. This involves taking a small sample of your blood and injecting it into the puncture. The hole will be sealed when the blood thickens (clots), and the headache will stop.
Trouble Urinating
An epidural will numb the nerves that alert you when your bladder is full. A catheter may need to be inserted to empty your bladder for you. You will likely regain bladder control once the medication has worn off.
Research on how epidurals affect the baby is somewhat ambiguous. The opioids in an epidural increase the risk that your baby will experience a change in heart rate, breathing problems, drowsiness, reduced muscle tone, and reduced breastfeeding. These effects will vary depending on many factors and are usually short-term.
It’s also possible that a baby may struggle with latching on during breastfeeding if an epidural is used during delivery. The baby may also become lethargic in the uterus and have trouble getting into position for delivery. This might explain the higher rate of surgical vaginal and C-section delivery in people who have epidurals.
It’s important to contact a healthcare provider if you develop complications, such as an infection or nerve damage, after you return home. A severe headache after an epidural can be a sign of a dural puncture. The dura is a membrane that surrounds cerebrospinal fluid (CSF), which cushions the spinal cord. A puncture causes CSF to leak.
See a healthcare provider right away if you develop other dural puncture symptoms, such as:
- Feeling dizzy
- Hearing loss
- Nausea
- Neck pain
- Pain, weakness, numbness, or tingling in the arms
- Tinnitus (ringing in the ears)
- Visual changes
