What are Epidurals?
Epidurals inject medication into the epidural space of the spine. They have been used for a variety of purposes. Epidural is a medical intervention that includes epidural anesthesia and epidural analgesia. The method of injecting substances into the epidural space, via a catheter, can have an effect where it blocks sensations and pain through the nerves around the spinal cord.
Epidural is not the same substance as spinal anesthesia, which is an injection of drugs that is put into the cerebrospinal fluid. In epidural anesthesia, a larger amount of medication is necessary, the onset is slower, and the catheter is indwelling in order for the effects to take hold and persist. In addition, unlike spinal anesthesia, it is easier for epidurals to achieve the effects of segmental analgesia or anesthesia. Finally, epidural injections can be placed anywhere along the vertebrae (sacral, cervical, lumbar, or thoracic) instead of just in the lumbar, a place that would be required for the injection of spinal anesthesia. Epidurals are most often used for analgesia, or pain management purposes.1
Epidural for Pregnancy
The most commonly known type of epidural is the one that is used on those who are undergoing the process of childbirth. Over 50% of women who engage in hospital births use the aid of epidural anesthesia. It is a regional anesthesia that is meant to just be used for pain management, and it is not injected for a total lack of feeling. These types of epidurals block nerves in the lower spine. The types of medications used are local anesthetics, such as lidocaine, bupivacaine, or chloroprocaine, in combination with narcotics or opiods (fentanyl and sufentanil).
First, IV fluids are given, then the patient has to arch their back while either sitting up or lying on their side. Antiseptic and, possibly, a local anesthetic is used on the surface area before the injection of the needle and catheter tube. The catheter is left in place so that medication can be infused or injected periodically or continuously. Besides the regular epidural, there is a type of “walking epidural” (combined spinal-epidural or CSE), which allows more freedom of movement. While some women choose to receive the administration of epidurals to reduce discomfort and increase relaxation during the childbirth process, others may opt out of using one for personal or medical reasons.
Possible Side Effects
Epidurals can cause the patient to experience quite a few possible side effects, such as a sudden drop in their blood pressure. The epidural may cause headaches, if spinal fluid leaks. Some women experience symptoms like ear ringing, backache, nausea, shivering, and find themselves having difficulty in urinating. Pushing the baby out may become more difficult as a result of the epidural, requiring other medical interventions to also take place during birth, such as forceps, vacuum extraction, Pitocin, or cesarean section. Numbness can persist even after the birth. Babies may also be affected by the medication. It is these risks that should be presented to and considered by the patient before said patient, in labor, makes the decision to have the epidural injection, as it is an important choice.2
Epidurals Steroid Injections
Epidural Steroid Injections (ESIs) can treat inflammation from neck-related arm pain and low back-related leg pain. When the spinal nerves become inflamed due to the narrowing of spinal passages, steroids such as cortisone may be able to help decrease pain. The conditions that cause this spinal narrowing and pain can include such bodily afflictions like disc herniation, bone spurs, and spondylolisthesis.3 ESIs can also be used for relieving the effects of other leg and low back pain causes, including sciatica and radicular pain. The pain relief is only temporary, as it may last from a week to a year, but it should be combined with a rehabilitation program that is structured to comprehensively help the patient recover through rehabilitative stretching and regular, safe exercise. Epidural steroid injections treat the lumbar, or low back, cervical, or neck, and thoracic, or mid-spine, regions.
One advantage of receiving epidural steroids is that the medication is injected near the actual source of the pain rather than being dispersed throughout the body, which would lead to more side-effects, such as the ones that occur from painkillers and oral steroids.4 There are three methods of performing ESIs, and these methods are interlaminar, also known as “epidural injection”, in which the steroid is delivered over a wider area, caudal, which is performed using just the sacral hiatus, and transforaminal, also known as “nerve block”, where the injection is put into the nerve sleeve for a concentrated delivery in one area. All of these injections are minimal enough in that they can be used for outpatient procedures. Side effects might include such changes “steroid flush”, menstrual changes, sleeping difficulties, and anxiety. Fortunately, however, these side effects should be just mild and temporary.5