Epidural for pain relief after surgery

What is an epidural?

The nerves from your spine to your lower body pass through an area in your back close to your spine. This is called the epidural space.

Local anaesthetics are injected into this space through a fine plastic tube, called an epidural catheter. This blocks the nerve messages, causing numbness. The extent of numbness will depend on how much local anaesthetic is used.

An epidural pump allows local anaesthetic to be given all the time.

Other pain relief drugs can also be added in small amounts. The amount of drugs given are carefully controlled. 

You may be able to press a button to give a small extra dose from the pump. Your anaesthetist will set the pump to limit the dose you can give. Overdose is very rare.

When the epidural is stopped, full feeling will return.

An epidural may be used during and, or after surgery for pain relief.

An epidural can be put in:

• when you are conscious
• when you are under sedation. (When you have been given a drug to make you drowsy and relaxed, but still conscious)
• or during a general anaesthetic

These choices can be discussed further with your anaesthetist.

a needle will be used to put a thin plastic tube into a vein in your hand or arm. This is called a cannula and is used to give you fluids.

you will be asked to sit up or lie on your side, bending forwards to curve your back. It is important to keep
still while the epidural is put in.

Local anaesthetic is injected into a small area of the skin of your back.

A special epidural needle is pushed through this area. A thin plastic catheter is then passed through the needle into your epidural space. The needle is then taken out, leaving only the catheter in your back.

You are more likely to die from a road accident or in your own home than suffer lasting damage from an epidural.

You may want to talk further about these risks with your anaesthetist.

(All risks quoted are approximate and assume best practice.)

What if I decide not to have an epidural?

It is your choice, you do not have to have one. There are several other ways to give pain relief with morphine that work well.

Injections can be given by the nurses or by a pump into a vein which you control by pressing a button. (Patient controlled analgesia).

There are other ways to give local anaesthetics. You may be able to take drugs for pain relief by mouth.

Every effort will always be made to make sure you are comfortable.

How do I ask further questions?

Ask the nurses or your anaesthetist.

Questions you may like to ask your anaesthetist

• Who will give my anaesthetic?
• Do I have to have this kind of pain relief?
• Have you often used this kind of pain relief?
• What are the risks?
• Do I have any special risks?
• How will I feel afterwards?

Useful organisations

Association of Anaesthetists of Great Britain and Ireland
21 Portland Place
London WC1B 1PY
 Phone: 44 20 7631 1650
Fax: 44 20 7631 4352
E-mail: info@aagb.org
Website: www.aagbi.org

This organisation works to promote the development of anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland.

Royal College of Anaesthetists
48-49 Russell Square
London WC1B 4JY.
Phone: 44 20 7813 1900
Fax: 44 20 7813 1876
E-mail:info@rcoa.ac.uk 
Website: www.rcoa.ac.uk

This organisation is responsible for standards in anaesthesia, critical care and pain management throughout the UK.

Adapted from a leaflet from The Royal College of Anaesthetists and The Association of Anaesthetists of Great Britain and Ireland. (March 2004 edition)

Very rare

permanent disabling nerve damage epidural abscess epidural haematoma (blood clot) cardiac arrest (when the heart stops)

Side effects and complications

All the side effects and complications described can happen without an epidural. Side effects are common, are often minor and are usually easy to treat. Serious complications are fortunately rare.

For major surgery, the risk of lasting nerve damage is probably about the same, with or without an epidural.

The risk of complications should be balanced against the benefits. They should also be compared with other methods of pain relief. Your anaesthetist can help you with this.

Very common or common side effects and complications

• Very common means that 1 in 10 people will be affected.
• Common means that 1 in 100 people will be affected.

Not able to pass urine. The epidural affects the nerves that supply the bladder. A catheter will usually have to be put in to drain it. This is often needed anyway after major surgery to check the kidney function.

With an epidural this will be painless.

The bladder returns to normal when the epidural wears off.

Low blood pressure. The local anaesthetic affects the nerves going to your blood vessels. Blood pressure therefore always drops a little. Fluids and or drugs can be put into your drip to treat this. Low blood pressure is common after surgery, even without an epidural.

Itching. This can be a side effect of morphine like drugs used together with local anaesthetic. It is easily treated with drugs.

Feeling sick and being sick. These can be treated with drugs. They happen less often with an epidural than with most other kinds of pain relief.

Backache. This is common, with or without an epidural. It is often caused by lying on a firm flat operating table.

Not enough pain relief. It may not be possible to place the epidural catheter. The local anaesthetic may not spread enough to cover the whole surgical area. Or, the catheter can fall out. Overall, an epidural usually gives better pain relief. Other methods can be used if the epidural fails.

Headaches. Minor headaches are common after surgery, with or without an epidural. People may get a severe headache after an epidural. This is because the lining of the fluid filled space around the spinal cord has been punctured. The fluid leaks out and causes low pressure in the brain, particularly when you sit up.

It may be necessary to inject a small amount of your blood into your epidural space. This is called an epidural blood patch. The blood clots and plugs the hole in the lining. It almost always works straight away.

For more information please see 'Headache after an epidural or spinal anaesthetic'.

Uncommon complications

• Uncommon means that 1 in 1000 people will be affected.

Slow breathing. Some drugs can cause slow breathing and, or drowsiness that needs to be treated.

Catheter infection. The epidural catheter can get infected and may have to be taken out. Antibiotics may be needed. It is very rare for the infection to spread any further than the area where the catheter was put in.

Rare or very rare complications

• Rare means that 1 in 10,000 will be affected.
• Very rare means that 1 in 100,000 will be affected.

Rare
convulsions (fits) breathing difficulty temporary nerve damage

No, an epidural may not always be possible. The risk of complications may be too high. The anaesthetist will ask you if:

you are taking drugs to thin your blood, such as warfarin you have a blood clotting abnormality you are allergic to local anaesthetics you have severe arthritis or deformity of the spine you have an infection in your back

It will be stopped when you no longer need it for pain relief The amount of drug being given by the epidural pump will gradually be reduced A few hours after the pump is stopped, the epidural tubes will be taken out, if you are still comfortable The catheter will be taken out if it is not working, another one can be put in if needed.

The nurses will regularly take your pulse and blood pressure The nurses will also ask you about your pain and how you are feeling.

They may adjust the epidural pump and treat side effects They will check that the pump is working correctly.

They will encourage you to move, eat and drink, in line with the surgeon's instructions The pain relief team doctors and nurses may also visit you, and will check your epidural is working properly

The local anaesthetic stings briefly, but there will usually be no pain.

It is common to feel slight discomfort in your back as the catheter is put in.

You may get a feeling like an electric shock or pain while the needle or catheter is put in. If this happens, you must tell your anaesthetist straight away.

You will gradually get a warm numb feeling. This is the same as after a dental anaesthetic injection. You may still be able to feel touch, pressure and movement.

Your legs feel heavy and increasingly difficult to move.

You may only notice these effects for the first time when you recover consciousness after your operation.

Particularly if your epidural was put in when you were anaesthetised.

For most people these feelings are not unpleasant, just a bit strange.

The numbness and weakness gradually gets less over the first day after your operation.

Better pain relief, particularly when you move.

Reduced complications of major surgery. For example - feeling sick and being sick leg and lung blood clots chest infections blood transfusions delayed bowel function quicker return to eating, drinking and full movement. Possibly with a shorter stay in hospital compared to other methods of pain relief.