Often the anesthetic and glucocorticosteroids.

Is epidural anesthesia included in the birth certificate?

It depends on the circumstances.

If epidural anesthesia is performed according to indications, it is included in the birth certificate. In this case, this type of medical care is provided free of charge.

But epidural anesthesia can also be performed at the request of the woman herself. In this case, it is an additional paid service that will have to be paid in full.

Is epidural anesthesia used during laparoscopy?

Epidural anesthesia is performed during laparoscopic surgical interventions, including in gynecology. But it can be used only for short-term procedures and those that are performed on an outpatient basis (without hospitalization). Disadvantages of epidural anesthesia during laparoscopic operations:

• Higher risk of oxygen deprivation due to increased levels of carbon dioxide in the blood.
• Irritation phrenic nerve, whose functions are not disabled during epidural anesthesia.
• The possibility of aspiration is the entry of saliva, mucus and stomach contents into the respiratory tract as a result of increased pressure in the abdominal cavity.
• With epidural anesthesia, it is often necessary to prescribe strong sedatives, which can suppress breathing - this further increases oxygen deprivation.
• Higher risk of cardiovascular system dysfunction.

In this regard, epidural anesthesia has limited use in laparoscopic operations.

What drugs are used for epidural anesthesia?

Drug name	Description
Novocaine	Currently, it is practically not used for epidural anesthesia. It begins to act slowly, the effect does not last long.
Trimekain	It acts quickly (numbness begins after 10-15 minutes), but not for long (the effect stops after 45-60 minutes). Most often used for epidural anesthesia through a catheter or in combination with other anesthetics.
Chloroprocaine	Just like trimecaine, it acts quickly (numbness begins after 10-15 minutes), but not for long (the effect stops after 45-60 minutes). It is used for short-term and outpatient interventions, as well as for epidural anesthesia through a catheter (in this case it is administered every 40 minutes).
Lidocaine	It begins to act quickly (10-15 minutes after administration), but the effect lasts quite a long time (1-1.5 hours). Can be administered through a needle or through a catheter (every 1.25-1.5 hours).
Mepivacaine	Just like lidocaine, it begins to act in 10-15 minutes and ends in 1-1.5 hours. It can be given through a needle or through a catheter, but this drug is not recommended for long-term pain relief during labor because it enters the bloodstream of the mother and baby.
Prilocaine	The speed and duration of action are the same as lidocaine and mepivacaine. This drug is not used for long-term pain relief and in obstetrics, as it negatively affects the hemoglobin of the mother and fetus.
Dicaine	It begins to act slowly - 20-30 minutes after administration, but the effect lasts up to three hours. This is enough for many operations. But it is important not to exceed the dose of the anesthetic, as otherwise its toxic effects may occur.
Etidocaine	It begins to act quickly - within 10-15 minutes. The effect can last up to 6 hours. This drug is not used in obstetrics, as it causes severe muscle relaxation.
Bupivacaine	It begins to act in 15-20 minutes, the effect lasts up to 5 hours. In low doses, it is often used to relieve pain during labor. This anesthetic is convenient because it acts for a long time and does not lead to muscle relaxation, so it does not interfere with labor. But with an overdose or injection into a vessel, persistent toxic effects develop.

What medications can affect epidural anesthesia?

Taking medications that reduce blood clotting is a relative contraindication to epidural anesthesia. A certain amount of time must pass between taking the medication and the procedure for its effects to wear off.

Drug name	What should you do if you are taking this drug*?	What tests need to be done before epidural anesthesia?
Plavix (Clopidogrel)	Stop taking 1 week before anesthesia.
Tiklid (Ticlopidine)	Stop taking 2 weeks before anesthesia.
Unfractionated heparin(solution for subcutaneous administration)	Conduct epidural anesthesia no earlier than 4 hours after the last injection.	If treatment with heparin lasted more than 4 days, it is necessary to take a complete blood count and check the platelet count.
Unfractionated heparin(solution for intravenous administration)	Conduct epidural anesthesia no earlier than 4 hours after the last injection. Remove the catheter 4 hours after the last insertion.	Definition prothrombin time.
Coumadin (Warfarin)	Conduct epidural anesthesia no earlier than 4-5 days after discontinuation of the drug.	Before administering anesthesia and before removing the catheter: definition prothrombin time; definition international normalized relations(blood clotting indicator).
Fraxiparine, Nadroparin, Enoxaparin, Clexane, Dalteparin, Fragmin,Bemiparin, Cibor.	Do not enter: in a prophylactic dose – 12 hours before the procedure; in a therapeutic dose – 24 hours before the procedure; after surgery or catheter removal - within 2 hours.
Fondaparinux (Pentasaccharide, Arixtra)	Do not administer within 36 hours before anesthesia; do not administer within 12 hours after completion of surgery or catheter removal.
Rivaroxaban	Epidural anesthesia can be administered no earlier than 18 hours after the last dose; administer the drug no earlier than 6 hours after completion of the operation or removal of the catheter.

*If you are taking one of these medications, be sure to tell your doctor. Do not stop taking it yourself.

All women experience pain during childbirth, the intensity of which depends on many factors - mental state, intensity and duration of contractions, speed of cervical dilatation, degree of stretching of perineal tissue, age, etc. Severe pain causes corresponding reactions of all organs and systems and can have a negative impact on the condition of the woman and the fetus.

Against this background, the elimination of pain becomes of great importance in the management of childbirth. In recent decades, the most effective and safe methods of pain relief for pregnant women are considered to be epidural analgesia during childbirth, spinal anesthesia and epidural (peridural) anesthesia during surgical delivery, which are various types of regional anesthesia.

General principles of pain relief methods

In accordance with the localization of receptors that perceive irritation, three types of sensitivity are distinguished:

1. Exteroceptive (pain, temperature and tactile), which represents information from receptors located in the skin and mucous membranes.
2. Proprioceptive - from receptors located in joints, tendons, muscles, etc.
3. Interoceptive - from receptors of internal organs, blood vessels, etc.

Most impulses from the nerve endings are transmitted along the nerves and further along the structures of the nerve roots to the spinal cord and further along the pathways to various centers of the brain. Thanks to this, some of them are perceived by consciousness, and a conscious or reflex response of the body to irritation is formed in the form of muscular, cardiac, vascular, endocrine and other reactions. In addition, the response can be formed through the structures of the spinal cord and along other nerve pathways.

The nerve pathways that conduct impulses during childbirth consist primarily of the following three components:

1. From the uterus to the spinal cord, at the level from the tenth thoracic to the first lumbar segments.
2. In the second stage of labor, irritation of the pelvic organs occurs. From them, impulses along additional pathways enter the spinal cord at the level from the fifth lumbar to the first sacral segments.
3. Irritation of the perineal tissue causes impulses, which are carried out in the 2nd - 4th sacral segments.

The purpose of anesthesia is to reduce the intensity or interrupt the flow of impulses to the spinal cord and/or to the brain and, accordingly, reduce or eliminate the negative response of the body of the woman in labor and the fetus.

The reduction of most types of sensitivity of part or the entire body is anesthesia, which is accompanied by a decrease in muscle tone or a complete absence of their contractions. In women giving birth, it is used in the form of general combined anesthesia, intravenous anesthesia, regional anesthesia, or a combination thereof, only if it is necessary to perform any other painful manipulations. These methods exclude the period of pushing and the possibility of a woman’s active, targeted participation in the birth process.

Unlike anesthesia, analgesia is a reduction, mainly, of pain sensitivity while maintaining other types of pain sensitivity and muscle contractions. Pain relief is carried out by injecting narcotic and non-narcotic analgesics into a vein or intramuscularly, inhaling a nitrous-oxygen mixture, and using regional methods of pain relief.

In recent decades, epidural analgesia for natural childbirth has gained great popularity. This is due to its high efficiency, relative safety for the woman in labor and the fetus, flexibility in the process of labor, preservation of the woman’s consciousness and active participation in the birth process, and the possibility of transferring to anesthesia if surgical delivery is necessary. The pros and cons of the technique are the reason that in some obstetric institutions the frequency of its use reaches 90%.

Is it painful to give birth with epidural analgesia?

Anesthesia using this method, unlike other types, allows you to almost completely block pain sensitivity. The sensations of pressure, “expansion”, temperature, position of the limbs and body in space, etc. are preserved.

Which is better - epidural anesthesia or general anesthesia?

The latter is related to:

• the complexity of individual selection of drugs for anesthesia and their dosage;
• changing their dosages before and after extraction of the fetus;
• difficulties and the possibility of failure of tracheal intubation, which leads to hypoxia of the mother and fetus;
• high risk of aspiration or regurgitation of gastric contents with subsequent development of aspiration distress syndrome;
• a sharp increase in blood pressure during laryngoscopy and tracheal intubation with subsequent acute disturbance of cerebral or coronary circulation, the development of eclampsia, acute heart failure, disturbance of the uteroplacental circulation;
• possible partial preservation of the woman’s consciousness during the operation;
• post-anesthesia depression of the newborn, requiring resuscitation measures, including artificial ventilation;
• many other risks.

Epidural anesthesia for caesarean section, like spinal anesthesia, consists of interrupting the flow of impulses of all types of sensitivity into the spinal cord by using local anesthetic solutions.

The latter enter the general bloodstream in minimal doses and are not capable of causing a toxic effect or any serious negative consequences for the child in the form of disruption of vital functions, especially breathing.

In addition, this method avoids all of the above risks, and immediately after the fetus is removed, the mother can see her child, which is of great importance for both. At the same time, there are certain risks and possible negative consequences of epidural anesthesia/analgesia, which can be avoided if the rules for its implementation are followed and the anesthesiologist is sufficiently experienced.

How is epidural anesthesia/analgesia administered?

Regional methods are carried out only by anesthesiologists who have undergone the necessary training and have sufficient experience. The ward must be equipped with all the necessary equipment to allow continuous monitoring of the mother and fetus, general anesthesia, and, if necessary, intensive care and resuscitation of the pregnant woman and fetus.

During the entire period of anesthesia and the first days after its cessation, the postpartum woman should be observed not only by an obstetrician-gynecologist, but also by an anesthesiologist. The issue of using regional methods of pain relief in all cases is decided by the anesthesiologist together with the obstetrician-gynecologist in the absence of contraindications and the consent of the woman in labor.

Preparation for manipulation

The preparatory stage includes an examination by an anesthesiologist and psychological preparation of the woman in labor, familiarizing the latter with the principles and stages of epidural anesthesia/analgesia, explaining the essence, feasibility of using these methods and their advantage over others, as well as obtaining consent from her.

Percutaneous catheterization of the peripheral vein is performed with a catheter marked 16G or more. In the presence of even slight dehydration and signs of hypovelaemia, correction of the disorders is necessary. In addition, to carry out regional anesthesia, it is necessary to ensure adequate contractility of the uterus and the effectiveness of contractions when labor is weak.

In order to prevent a significant decrease in blood pressure during regional anesthesia due to partial blockade of the sympathetic nerves and nerve ganglia after the administration of the anesthetic, vasodilation, as well as muscle relaxation and an increase in the volume of the bloodstream, intravenous drip administration of at least 1 liter of isotonic saline solutions is necessary before the start of anesthesia (pre-infusion).

Preinfusion should be carried out before the start of epidural analgesia if it is preceded by a long period of labor, accompanied by restriction of fluid intake.

Technique and preparations

The procedure is carried out in conditions corresponding to the sterility of the operating room with the capabilities of intensive care and resuscitation.

The woman lies preferably on her left side, her legs are brought to the stomach as much as possible (if possible) by bending the knee and hip joints and held with the right hand by the area of ​​the knee joints. The left hand is placed under the head, which is brought as far as possible by the chin to the sternum. The back is given an arched position. This is necessary to increase the distance between the vertebrae at the site of the needle.

It is also possible to give the woman a sitting position with her knees brought to her stomach, her head bent and her back arched. In the selected position, the skin of the back is treated with an antiseptic solution and covered with a sterile sheet with a “window”.

Does it hurt to “do”? The procedure itself is painless, since at the puncture point with a special needle (Tuohy needle), the skin and subcutaneous tissue are first anesthetized with a thin needle using a solution of Novocaine or Lidocaine. Further manipulations are usually completely insensitive.

Then, a Tuohy needle (with the required lumen diameter) connected to a syringe filled with an isotonic solution and an air bubble is carefully inserted into the epidural space. In this case, after piercing the yellow ligament, the anesthesiologist feels the “failure” of the needle into the “emptiness”.

After identifying its presence in the epidural space, for which there are various tests (except for the sensation of “failure”, “hanging drop”, absence of deformation of the air bubble in the syringe, free insertion of the catheter, absence of cerebrospinal fluid in the needle), a special catheter is inserted into it through the lumen of the needle in the head direction by 3-4 cm.

The needle is removed, a sealed cannula with a filter is put on the opposite end of the catheter, and the catheter is fixed with sterile material along the spine and then brought out to the upper anterior surface of the chest. Subsequently, a local anesthetic solution is injected through the catheter.

Previously, in order to exclude incorrect position of the catheter (in a vessel or subarachnoid space), no more than 3 ml of a 2% solution of Lidocaine (test dose) is injected. After the first dose is administered, the woman in labor should remain in bed under observation for half an hour. At this time, her hemodynamics, breathing and general condition, and the condition of the fetus are monitored and assessed. After this, if the motor block of the lower extremities does not develop, she is allowed to get out of bed and walk.

Levels of epidural anesthesia/analgesia - puncture catheterization is carried out at the level between the II and III or between the III and IV lumbar vertebrae, which allows pain relief during contractions and dilation of the cervical canal, vagina and perineal area.

If a cesarean section is necessary, a larger amount of solution is injected at the same level or puncture catheterization is performed between the I and II lumbar vertebrae. In these cases, anesthesia reaches a level of 4 cm or more, above the navel. This relieves the period of pushing and provides the opportunity to perform surgical intervention while maintaining the woman’s full consciousness and adequate indicators of her physiological condition.

Does epidural analgesia/anesthesia affect the child?

When used correctly, the doses and concentrations of local anesthetic drugs used do not have any negative effect on the child, unlike general inhalation anesthesia or analgesic drugs administered intravenously and intramuscularly to the woman in labor. Moreover, regional methods of pain relief help improve uteroplacental circulation.

The main drugs for epidural anesthesia are Lidocaine, Bupivacaine (Marcaine), Ropivacaine (Naropin), which is an analogue of the latter, but has a less pronounced side effect on the heart and blood vessels. For the purpose of analgesia during labor, the same drugs are used, but in different concentrations and dosages.

How long does anesthesia last for caesarean section and analgesia for childbirth?

The required effect of Lidocaine develops 10-15 minutes after administration and lasts up to 1.5 - 2 hours, for the rest - 20-25 minutes and 2-4 hours, respectively. If necessary, repeated bolus injections of drugs are possible, but in smaller volumes. There is also a method of drip administration.

How long does epidural analgesia last?

This period usually corresponds to the above-mentioned duration of action of the drugs, and recovery from epidural anesthesia, including complete restoration of muscle tone, depends on the duration of the surgical procedure and, accordingly, the amount of anesthetic administered. This usually lasts another 2-4 hours.

How is spinal anesthesia different from epidural?

The principle of the technique for performing them is identical, and the drugs used are the same. Main differences:

• the first is technically easier to implement;
• different puncture needles (in the first case, their diameter is much smaller and their length is longer);
• puncture level - mainly between the I and II lumbar vertebrae, in case of technical difficulties - between the II and III lumbar vertebrae;
• the needle is passed beyond the epidural space (into the subarachnoid space) until cerebrospinal fluid appears in the needle;
• the volume of injected anesthetic is 10-15 times less, and the severity of the block is higher;
• after the introduction of an anesthetic drug into the subarachnoid space, the period before the onset of anesthesia is much shorter and is usually no more than 5 minutes;
• higher risk of hemodynamic disorders and less time for their correction, due to the rapid onset of block;
• greater risk in terms of developing subsequent complications (headache, aseptic arachnoiditis, meningitis may develop).

Indications and contraindications

Indications for epidural analgesia and anesthesia in obstetrics are so wide that when choosing them, mainly contraindications are taken into account.

Main indications:

1. The desire of the woman in labor.
2. Insufficient effectiveness of alternative methods of pain relief.
3. The course of labor with severe pain during contractions.
4. Presence, especially severe.
5. The presence of concomitant diseases such as arterial hypertension of any etiology, bronchial asthma, some types of heart disease, chronic glomerulonephritis, high myopia.
6. Some types of labor anomalies (uterine incoordination).
7. C-section.
8. Delivery using obstetric forceps.

The main absolute contraindications to epidural anesthesia and analgesia:

1. Woman's refusal and intolerance to local anesthetic drugs.
2. Insufficient experience of the anesthesiologist in mastering these methods and monitoring the condition of the woman in labor.
3. The presence of a skin inflammatory process in the area of ​​the proposed puncture.
4. Septic conditions.
5. Reduced platelet count in the mother's blood, disseminated intravascular coagulation syndrome, coagulopathy, therapy with anticoagulant drugs.
6. Bleeding, severe hypovolemia and dehydration.
7. The presence of convulsive syndrome or its likelihood (with eclampsia).
8. Fixed and low cardiac output in the presence of an artificial pacemaker, aortic stenosis or severe mitral valve stenosis, coarctation of the aorta.
9. Significant deformation of the spine, diseases of the central nervous system, peripheral neuropathy, signs of increased intracranial pressure.
10. Fetal distress syndrome (severe) or cardiac dysfunction.

There are also relative contraindications, but most of them are agreed upon with the obstetrician-gynecologist. How can the procedure be dangerous?

Complications after epidural anesthesia/analgesia

After using regional methods, various complications are possible. For example, headaches may sometimes appear. These phenomena persist for some time. They are usually associated with the leakage of cerebrospinal fluid through a puncture in the dura mater during spinal anesthesia or accidental damage to it during puncture of the epidural space.

In addition, in rare cases, they may be caused by the development of arachnoiditis (inflammation of the arachnoid mater) due to injury, irritation by anesthetic, or infection.

Sometimes after epidural anesthesia/analgesia, the back and lower back hurt, which is usually caused by damage to the radicular nerves during puncture or the formation of a hematoma in this area, which puts pressure on the nerves.

An insufficient degree of anesthesia or “mosaic” anesthesia is also possible. But much more dangerous are complications such as:

1. A marked decrease in blood pressure (more than 20%) after the administration of an anesthetic drug.
2. High level of spinal block with respiratory and cardiac dysfunction and collapse, usually associated with accidental catheter or needle perforation of the subarachnoid space and administration of anesthetic at a dose intended for the epidural space.
3. The toxic effect of anesthetics when a catheter is accidentally inserted into a blood vessel, which is accompanied by a change in the woman’s behavior, loss of consciousness, convulsive syndrome, and circulatory arrest.

So, excessive pain during childbirth and the influence of drugs for general anesthesia are far from harmless for the woman in labor, the fetus and, subsequently, for the newborn. Regional methods are currently the most adequate and effective. When performed correctly, serious side effects are practically excluded.

Any surgical procedure requires the use of some type of anesthesia. There are types of operations for which control over the patient is important. Spinal anesthesia has consequences and requires a highly qualified anesthesiologist, but keeps the patient conscious throughout the entire process.

Spinal anesthesia numbs only the lower part of the body, from the waist to the toes. In this case, the patient will remain conscious and will be able to report his condition. With this method, an anesthetic is injected into the back, near the spinal cord.

How is spinal anesthesia performed:

1. the patient is in a sitting position, with his back to the doctor, or lying on his side. At the same time, he bends his back and presses his chin to his chest, trying to immobilize his body as much as possible;
2. the anesthesiologist determines the injection site with his fingers;
3. the area is treated with a special agent to make it sterile;
4. To begin with, local anesthesia is performed. If it is necessary;
5. a thin needle is inserted very slowly and the drug is injected. Then carefully remove the needle and cover the wound with a sterile bandage.

The patient may immediately feel side symptoms such as tingling in the legs, heat throughout the body. Complete pain relief occurs 10 minutes after administration of the drug.

Why can't you get up after spinal anesthesia? This type of anesthesia completely immobilizes the lower part of the body. Trying to stand up may result in a fall and injury.

Indications for use

Spinal anesthesia is given when necessary. To keep the patient conscious. It is used during operations affecting the perineum, legs and genitals of a person.

Advantages of spinal anesthesia:

1. reduces sensitivity of the lower body;
2. allowed for lung diseases;
3. reduces muscle tone of the small intestine. Which allows you to perform operations more accurately;
4. allowed for heart failure.

This method of pain relief is used in the following cases:

• during natural childbirth, it helps relieve pain from contractions and the process of delivery. Stimulates labor before it begins;
• during operations on the legs and intestines that do not require removal of organs;
• caesarean section. Prevents harm to the baby. The only contraindication is low blood clotting and heart rhythm disturbances in a pregnant woman. Blood loss during surgery is also reduced;

To assess whether the drug has worked, the doctor uses a thin needle to pierce the patient’s limb, checking whether he feels pain. A wet cotton ball is also used to assess sensations if the patient does not feel cold. This means the pain relief was successful.

The body recovers after anesthesia from 2 to 4 hours, the time depends on the drug used.

Contraindications

Spinal anesthesia is increasingly used for various operations. It allows you to maintain the patient’s consciousness and perform complex manipulations. During childbirth, epidural anesthesia will relieve excruciating pain and help perform a caesarean section.

Spinal anesthesia is used for many operations, but it has a number of contraindications:

1. skin infections;
2. allergies to drugs;
3. diseases of the central nervous system;
4. risk of complications and lack of resuscitation;
5. patient refusal of spinal anesthesia.

In addition to contraindications related to the patient’s health, the following is prohibited before the spinal anesthesia procedure:

• smoke;
• drink 6-8 hours before surgery;
• apply cosmetics;
• wear metal jewelry;
• It is recommended to remove lenses and dentures.

Complications after spinal anesthesia can be caused by failure to follow these rules. Doctors advise telling the anesthesiologist about all chronic diseases, allergic reactions, internal fears and worries.

Women note that spinal anesthesia makes labor easier and accelerates the dilation of the cervix. After any anesthesia, the patient needs time to recover. Experts do not advise getting up after spinal anesthesia for 3-4 hours.

Complications

It is impossible to predict the body's reaction to the administered drug. The consequences of spinal anesthesia can be either mild or severe.

Mild side effects that occur in the first minutes after anesthesia include:

1. headache occurs due to decreased blood pressure and may persist for 24 hours;
2. urinary retention and swelling. Although the consequences for men are almost minimal, urinary retention occurs more often in them than in women. It occurs due to stopping the functions of the bladder;
3. decrease in blood pressure. This occurs due to dehydration and may also be a consequence of heart failure.

These consequences for women and men do not require treatment or medical intervention. Within 24 hours after surgery, all side effects will subside.

The effects of spinal anesthesia after surgery in some cases are severe. They will require complex and lengthy treatment.

What are the consequences after spinal anesthesia:

• an allergic reaction to the drug can cause pulmonary edema and lead to suffocation;
• traumatic damage to the roots leads to complete or partial paralysis of the limbs. The cause is incorrectly administered anesthesia;
• meningitis - inflammation of the membranes of the brain caused by bacteria and viruses;
• spinal hematoma - an accumulation of blood leading to compression of the spinal cord;
• persistent headache accompanied by vomiting and dizziness.
• blood infection. This happens in case. If the needle insertion site has not been properly disinfected.

Treatment of complications after spinal anesthesia will require a lot of time and effort. If the procedure is performed correctly, there will be no pain or unpleasant side effects.

Anesthesia during childbirth

Epidural anesthesia is performed only with the personal consent of the patient. Doctors recommend this type of pain relief for medical reasons, but in some clinics you can provide it at your own request.

Spinal anesthesia during labor eases contractions and stimulates the cervix to dilate. During labor, it is recommended in the following cases:

• if childbirth is carried out at a short term, spinal anesthesia will help relax the pelvic muscles;
• high blood pressure in a pregnant woman;
• weak labor activity or its absence;
• fetal hypoxia;
• very painful contractions;
• caesarean section for multiple pregnancies, breech presentation of the fetus, entanglement of the umbilical cord or large weight of the baby.

Long-term consequences of spinal anesthesia after childbirth are often associated with back pain. If the pain does not go away for a long time, it is recommended to consult a doctor for medical help.

Also, after spinal anesthesia, lifting heavy objects is not allowed. If it was used during childbirth, the rehabilitation period for the woman is 24 hours. Proper nutrition and proper rest after surgery help the body regain strength.

Every day, a large number of operations are performed in medical clinics. Surgery is impossible without appropriate anesthesia, that is, anesthesia is required, otherwise it will be simply unbearable to endure such pain. There are many types of anesthesia. In this article we will look at what epidural anesthesia is, in what cases it can be used, and whether there are any contraindications.

What is epidural anesthesia

This type of pain relief is one of the regional epidural methods - it is the introduction of medications directly into the epidural space of the spinal column through a catheter. During such anesthesia, the following results can be achieved:

• Loss of pain sensitivity.
• General sensitivity decreases or almost disappears.
• Muscle relaxation.

The mechanism of action of epidural anesthesia is due to the fact that the medicine penetrates through the dural couplings, as a result of which the passage of nerve impulses is blocked.

How epidural anesthesia works

In humans, the spinal column and nerve endings in the neck are located in the dura mater. The epidural region is located around the membrane and runs along the spine. Nerves in the direction of the neck, arms and shoulders cross it, their inflammation leads to pain in the epidural area.

Medicine injected into this area causes loss of sensation and dullness of pain. The transmission of nerve impulses is blocked, which gives this effect.

When is epidural anesthesia used?

Considering that this type of anesthesia is used during surgery in various areas of the body, we can say that the risk of use may be greater or lesser. For example, epidural anesthesia for the chest, groin, legs, and abdomen is less risky than analgesia for the neck and arms. The use of such anesthesia for the head is impossible, because the innervation of this part of the body is carried out using the cranial system.

Epidural anesthesia is most often used:

1. As a local anesthetic if surgery is not intended, for example, during labor.
2. As an adjunct to general anesthesia, it is then possible to reduce the amount of opioids used.
3. Epidural anesthesia is often used for caesarean section.
4. In the postoperative period to relieve pain.
5. For the treatment of back pain. In this case, steroid drugs and analgesics are injected into the epidural area.

The doctor decides which anesthesia to give preference to, general anesthesia or epidural, in each specific case.

Methods of epidural anesthesia

Every year, more and more new tools for this type of pain relief appear in the arsenal of doctors. When doctors are faced with a choice between general or epidural anesthesia, they choose the latter if possible. A large selection of medications for its implementation allows you to choose the most suitable option for each patient.

In addition to the variety of drugs for anesthesia, there are various methods of such anesthesia:

1. Continuous. In this case, the anesthetic is injected into the spinal space continuously. In this way, you can achieve pain relief for the entire period of the operation, and less medication will be required.
2. Periodic administration. The supply of the drug is ensured only when there is an urgent need for it.
3. Pain relief at the request of the patient. When using this method, the patient has a button under his hands. If there is a need for pain relief, then when you press it, part of the medicine is delivered to the epidural area.

Doctors have medications that perfectly relieve pain, but maintain mobility and keep consciousness clear.

In what cases is epidural anesthesia indicated?

Most surgeons consider this method of anesthesia the most suitable during leg operations. It allows not only to relieve pain and relax the muscles as much as possible, but also to reduce blood loss.

Indications for the use of epidural anesthesia may vary, for example:

1. This method is absolutely safe for the kidneys and prostate gland.
2. Used for abdominal and pelvic organs.
3. Widely used during surgery on the stomach and intestines.
4. Can be used for heart defects and diabetes.

But this does not mean that epidural anesthesia is always used for such pathologies. Everything is decided in each case individually.

Contraindications for use

Epidural anesthesia has the following contraindications: categorical and relative. The first category includes:

Relative contraindications are much broader and include:

• Excess weight.
• Poor body condition.
• Chronic diseases of the spinal column.
• Childhood.
• Diseases of a neurological nature.
• Severe hypotension and many others.

The quality of epidural anesthesia will depend not only on the existing pathology and health status of the patient, but also on the drug that is supposed to be used.

Epidural anesthesia for caesarean section

When all the indications for a cesarean section are available, an epidural is often used instead. This method is selected in advance, as it requires some preparation.

The drug is administered to a specific place at the lumbar level, where the nerve endings exit the spinal cord. The drug is administered through a special catheter tube; medication can be added at any time during the operation.

As a result of such anesthesia, consciousness remains clear, and sensitivity below the belt disappears. The woman can see and hear doctors, but does not feel pain.

When choosing between epidural or general anesthesia for caesarean section, it is worth considering the indications and contraindications for anesthesia.

Indications for such anesthesia

Most often, epidural anesthesia is used:

1. If labor begins ahead of time, for example, at 36-37 weeks. This anesthesia relaxes the pelvic muscles, and the baby’s head does not experience as much stress as it moves through the birth canal.
2. Severe hypertension.
3. when different parts of the uterus contract at different rates. Epidural anesthesia reduces the intensity of the contraction.
4. During prolonged labor, when there is no complete relaxation for a long time. This can lead to birth abnormalities, so epidural anesthesia is used to help the woman gain strength.

Contraindications

In addition to the indications, in the case of cesarean section there are also contraindications for such anesthesia, these include:

• The presence of an inflammatory process at the puncture site.
• Infectious diseases.
• Allergic reaction to drugs.
• If there is a scar on the uterus.
• If the child is located transversely or takes an oblique position.
• Narrow pelvis of a woman in labor.
• Large baby weight.
• If the woman herself does not want this type of anesthesia, then doctors cannot use it against her will.

Before using epidural anesthesia, the consequences, disadvantages and advantages must be considered.

Benefits of epidural anesthesia for caesarean section

The advantages of this type of pain relief include:

1. The woman remains conscious throughout the operation; there is no risk of intubation or aspiration.
2. There is no irritation of the upper respiratory tract, as with general anesthesia, which is especially preferable for patients with asthma.
3. The cardiovascular system works stably, since the drug acts gradually.
4. The relative ability to perform movements is preserved.
5. With this anesthesia, you can increase the time of pain relief, since anesthetic is injected through the catheter at any time.
6. After surgery, opioid medications may be given to relieve pain.

In addition to the advantages, it is necessary to note the disadvantages of such anesthesia.

Disadvantages of epidural anesthesia

Any method of surgical intervention, as well as anesthesia, has its drawbacks. The disadvantages of epidural pain relief include:

1. The anesthesiologist made a mistake when administering the drug, when the medicine gets inside the vessel. This can lead to seizures and a sharp decrease in blood pressure.
2. There is a danger of subarachnoid injection, as a result of which a total spinal block develops.
3. To perform such anesthesia, you must have good skills, since this anesthesia is the most difficult.
4. The drug begins to act only after 15-20 minutes, so surgery cannot begin immediately.
5. There is a risk of inadequate pain relief when the nerve endings are not completely blocked, and discomfort remains during the operation.
6. It is necessary to carefully select drugs for such anesthesia during cesarean section, as some can penetrate the placenta and cause disturbances in the breathing and heart rate of the fetus.
7. After the operation, you may feel back pain and headache.

To make the right choice if you are going to have an epidural or general anesthesia, you need to weigh the pros and cons. Take into account existing contraindications and choose the most suitable type of anesthesia.

Complications of epidural anesthesia

Epidural anesthesia rarely causes complications, although such cases do occur.

Most often noted:

1. In 1 out of 20 patients, the drug does not fully act, and the nerve endings are not completely blocked, which means that pain relief will be ineffective.
2. In the presence of coagulopathy, there is a risk of hematoma formation.
3. Accidental injury during puncture may result in leakage of cerebrospinal fluid into the epidural area. This can lead to headaches after surgery.
4. A large dose of pain medication may be toxic, resulting in an ineffective blockade.
5. There may be side effects from the use of specific pain medications.

From all of the above, we can conclude that epidurals have serious health consequences in very rare cases.

Epidural anesthesia is used as the main type of pain relief. This type of regional anesthesia is highly effective and has few side effects. Let's look at it in more detail, highlighting the indications, features and contraindications.

Epidural anesthesia - indications

Epidural anesthesia for cesarean section is carried out at the request of the woman in labor. Many expectant mothers who are scheduled for a planned section prefer this type of anesthesia directly. With such anesthesia, the woman remains conscious, hears the first cry of her baby, but feels absolutely nothing. There are also factors in the presence of which epidural anesthesia is mandatory for cesarean section. Among them:

• Availability ;
• high blood pressure;
• liver and kidney diseases;
• severe myopia;
• diabetes;
• contraindications to general anesthesia;
• excessive labor;
• pathological conditions of the uterus.

How is a caesarean section performed with epidural anesthesia?

Women preparing for surgery often ask doctors how a caesarean section is performed with epidural anesthesia. Before the surgical intervention begins, the pregnant woman sits down on the couch or lies on her side. The area of ​​the spinal column where the needle is inserted is carefully treated with an antiseptic. After the onset of anesthesia, doctors make an incision in the lower abdomen, slightly above the pubis. Expanders are placed on the surgical wound, allowing access to the fetus.

After carefully opening the amniotic sac, doctors begin to remove the fetus. After successfully completing this stage, the baby's umbilical cord is cut and a clamp is applied. The mother is given Oxytocin to remove the placenta. After this, suturing is performed. After a few months, a scar remains at the site of the suture, which is practically invisible and does not cause any inconvenience to the mother.

How is epidural anesthesia given for caesarean section?

Epidural anesthesia for caesarean section is often administered in a sitting position. In this case, the patient is asked to take a position: spread her legs at the knees, put her ankles on the bed, bend her back, tilting her cervical spine. An alternative is to position the woman lying on her side (usually on the right). However, medical practice shows that it is easier to administer the anesthetic with the patient in a sitting position.

An anesthetic, using a special needle, is injected into the space between the wall of the spinal canal and the dura mater of the spinal cord (epidural space). A special, thin sterile tube (catheter) is inserted through the needle, which is left to administer the anesthetic. Epidural anesthesia during a caesarean section involves dosing the drug: increasing the concentration or stopping its supply.

Is it painful to have an epidural after a caesarean section?

A procedure such as epidural anesthesia is practically painless for the patient herself. Before the puncture, doctors administer local anesthesia. A pregnant woman may feel slight discomfort and slight pain only at the moment of puncture. Otherwise, the procedure does not cause pain and is well tolerated by pregnant women. The expectant mother's worries about the pain of such a procedure as epidural anesthesia during a caesarean section are groundless.

How long does a caesarean section last with epidural anesthesia?

A caesarean section under epidural anesthesia lasts no more than half an hour. In this case, on average, from the moment of insertion to the removal of the fetus from the abdomen, 10-15 minutes pass. The rest of the time is spent on suturing the postoperative wound. At the same time, the woman is given a hormone to expel and deliver the placenta. To prevent infection, the mother is also given antibacterial drugs.

Caesarean section under epidural anesthesia - sensations

With proper anesthesia, the woman does not feel anything during the operation. The sensations experienced during caesarean section under epidural anesthesia are associated with the onset of action of the anesthetic. After the injection, the pregnant woman begins to notice warmth and a feeling of heaviness in her legs. After some time, the expectant mother completely does not feel the lower part of the body - everything below the injection site. Mild numbness spreads throughout the body. This phenomenon may be accompanied by slight tingling, a feeling of goosebumps, which disappears after complete anesthesia.

How long does epidural anesthesia last after cesarean section?

Epidural anesthesia for caesarean section lasts about 2 hours. Immediately during this time, doctors forbid the woman to get up after the operation. With this type of anesthesia, blood flow in the lower extremities slows down. Because of this, if you try to stand up, your legs become weak and there is a high risk of falling. In addition, headaches and dizziness often occur after surgery, which worsen the well-being of the new mother.

Epidural anesthesia for caesarean section - consequences

Consequences after epidural anesthesia during cesarean section are often associated with non-compliance with contraindications to its behavior or with a violation of the pain management algorithm itself. In this case, complications can be observed both on the part of the mother and the baby. It is worth noting the consequences of epidural anesthesia for a woman in labor (during childbirth):

• injury to the dura mater of the spinal cord;
• decreased heart rate;
• the appearance of nausea and vomiting;
• allergic reaction to anesthetic.

Disorders can develop in a new mother in the postpartum period:

• back and head pain;
• violation ;
• decreased sensitivity in the legs;
• dysfunction of the central nervous system.

Poorly performed epidural anesthesia for caesarean section can also affect the condition of the baby:

• decreased heart rate (bradycardia);
• disruption of the breathing process;
• disturbance of the sucking reflex;
• disorientation;
• encephalopathy.

Back pain after epidural anesthesia for cesarean section

Epidural anesthesia for cesarean section, the consequences of which are mentioned above, often results in back pain for a woman after the birth of the child. There could be many reasons for this. Epidurit is an inflammatory process in the epidural space that is dangerous. This complication develops due to the long stay of the catheter in the back or when part of it remains. In addition, pain may worsen after surgery due to an existing vertebral hernia.

Other causes of back pain are directly related to improper conduct of a procedure such as epidural anesthesia for caesarean section, and the body’s reaction to the anesthetic. Due to the lack of extensive experience, the doctor can injure the hard shell where the nerve roots are located with an injection needle. Separately, it is necessary to highlight phantom pain, which is directly related to the psychological state of the patient.

Headaches after epidural anesthesia for cesarean section

When talking about the consequences and complications of epidural anesthesia for caesarean section, it is necessary to highlight frequent headaches after surgery. Their appearance is associated with the effect of the anesthetic component on the body. This reaction is observed in 50% of patients who have undergone epidural analgesia. The duration of pain ranges from several hours to several weeks. Headache can also be caused by changes in intracranial pressure due to the leakage of cerebrospinal fluid into the epidural space (if the lining of the brain is damaged).

Such situations require surgical intervention. The operation consists of repeated puncture and suction of fluid using a special device. After the manipulation, a blood patch is placed at the puncture site. The patient's blood taken from a vein is injected at the puncture site. As a result, the outflow of cerebrospinal fluid is blocked. The woman notices relief in her state of health the very next day after the procedure.