Epidurals inject medication into the epidural space of the spine. They can be used for a variety of purposes.
What are Epidurals?
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 block sensations and pain through the nerves around the spinal cord. Epidural is not spinal anesthesia, which is injection of drugs into the cerebrospinal fluid. In epidural anesthesia, a larger amount of medication is necessary, the onset is slower, and the catheter is indwelling. In addition, unlike spinal anesthesia, it is easier for epidurals to “achieve 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, as would be required for spinal anesthesia. Epidurals are most often used for analgesia (pain management) purposes.1
Epidural for Pregnancy
The most commonly known type of epidural is the one used in childbirth. Over 50% of women in hospital births use epidural anesthesia. It is a regional anesthesia just used for pain management, not 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 arches the back while sitting up or lying on their side. Antiseptic (and possibly a local anesthetic) is used 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 epidurals to reduce discomfort and increase relaxation, others may opt out of using one. Epidurals can cause a “sudden drop in blood pressure”. They may cause headaches, if spinal fluid leaks. Some women have ear ringing, backache, nausea, shivering, and difficulty urinating. Pushing the baby out may be more difficult, requiring other medical interventions during birth (i.e., forceps, vacuum extraction, Pitocin, or cesarean section). Numbness can persist after birth. Babies may also be affected by the medication.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 get inflamed due to the narrowing of spinal passages, steroids such as cortisone can decrease pain. The conditions that cause the narrowing can include discherniation, bone spurs, and spondylolisthesis.3 ESIs can also be used for other leg and low back pain causes, including sciatica and radicular pain. The pain relief is temporary (from a week to a year), but it should be combined with a “comprehensive rehabilitation program”, including “rehabilitative stretching and exercise”. Epidural steroid injections treat the lumbar (low back), cervical (neck), and thoracic (mid-spine) regions. The advantage of receiving epidural steroids is that the medication is injected near the pain’s source instead of being dispersed throughout the body with more side-effects, such as the ones from painkillers and oral steroids.4 There are three methods of performing ESIs: interlaminar/“epidural injection” (delivering the steroid over a wider area), caudal (using just the sacral hiatus), and transforaminal/“nerve block” (injecting into the nerve sleeve for a concentrated delivery in one area). All of these injections are outpatient procedures. Side effects might include “steroid flush”, menstrual changes, sleeping difficulties, and anxiety; however, these should be mild and temporary.5