Epidurals, Pain Relief Options During Delivery

Epidurals & Pain Relief Options During Delivery

Pain releiving medications can be divided into analgesics and anesthetics. Analgesics relieve pain without total loss of feeling or muscle movement. They are used to lessen pain but usually do not stop pain completely. Anesthetics block all feeling, including pain.

According to the extent of body area they affect, analgesics and anesthetics can be divided into 3 groups as systemic, regional and local.

Systemic analgesics during labour are usually given as a shot. They have more side effects than local and regional analgesics. These side effects can be summarised as nausea, drowsiness and difficulty in concentrating. They can affect the baby’s heart rate and slow down fetal breathing after birth.

Local anesthetics can be given as an injection to a small area to produce numbness and block pain in that area.They are preferred in patients who need an episiotomy just before delivery.

What types of regional anesthesia exist?

Regional analgesia and anesthesia is the application of medications through a special catheter on the patient’s back to decrease or block pain below the waist.

There are three types of regional anesthesia methods used during labour and delivery:

• Epidural anesthesia,
• Spinal anesthesia,
• Combined spino-epidural anesthesia.

How is epidural anesthesia administered?

Epidural anesthesia is the method used most commonly during labour and delivery. A catheter is inserted into the patient’s lower back and it stays in place throughout labour,for continuous infusion of pain- relief medications.

An epidural block can be used during labor and for a vaginal delivery or cesarean delivery. For labor and vaginal delivery, several medications may be given through the epidural catheter.

There may be some numbness in the lower areas of the body, but the patient will be awake and will be able to walk, move her legs and push during delivery. With higher dosages the patient may not be able to walk.

For a cesarean delivery, epidural catheter can be used with higher dosage of anesthetic medication. Than delivery so that the patient will not be feeling the lower part of her body. When compared to spinal or combined spinal-epidural anesthesia, epidural anesthesia by itself may be less effective in pain relief for patients having a cesarean delivery.

Itching is a common side effect if opiods are used and can be relieved by anti -histaminic medication injections.

How long does an epidural take to work?

Because the medication needs to be absorbed into several nerves, it may take a short time for it to take effect. Pain relief should begin within 10–20 minutes after the medication has been injected.

Are there any risks with epidural anesthesia?

Epidural anesthesia can cause the following side effects very rarely:

• Headache: If the covering of the spinal cord is pierced while the tube is being placed and spinal fluid leaks out, you can get a bad headache. This happens rarely.
• Decrease in blood pressure: An epidural can cause your blood pressure to decrease. This, in turn, may slow the baby’s heartbeat.
• Fever: Some women develop a low-grade fever as a normal reaction to an epidural.
• Soreness: After delivery, your back may be sore for a few days.

Serious complications with epidurals are very rare:

• There is a small risk that the anesthetic medication could be injected into one of the veins in the epidural space. This can cause dizziness, rapid heartbeat, a funny taste, or numbness around the mouth when the epidural is placed.
• If anesthetic enters your spinal fluid, it can affect your breathing muscles and make it hard to breathe.

How is spinal anesthesia administered?

Spinal anesthesia is a short acting form of regional anesthesia. Its effect starts quickly but lasts for only a few hours. A catheter is inserted through the patient’s lower back and the medication is injected into the spinal fluid. The patient has numbness on the lower body and will not be able to move the legs or may need assistance for moving depending on the medication dosage.

Is there any risk with spinal anesthesia?

Spinal anesthesia can cause the same side effects as epidural anesthesia.

How is combined spinal–epidural (CSE) anesthesia administered?

It is a combination of epidural and spinal anesthesia, therefore it has the benefits of both forms of anesthesia. Its action starts quickly due to spinal anesthesia and the epidural anesthesia can be used to relieve pain continuosly. Another advantage is that lower doses of medication will be necessary with CSE anesthesia.

It may be possible for the patient to walk but most hospitals find it safer that the patient stays in bed.

Is there any risk with combined spinal-epidural anesthesia?

A combined spinal-epidural anesthesia has the same risks as an epidural block.

How is general anesthesia administered?

General anesthesia causes the patient to lose consciousness so that she does not feel pain. It usually is used only for emergency situations during childbirth.

Medications are either given through iv line or with a mask. After the patient is asleep, endotracheal tube will be inserted through the mouth for ventilation of the lungs.

Are there any risks with general anesthesia?

Very rarely, especially if the patient’s stomach is full, she can aspirate food or liquids into the lungs which can lead to serious lung infection. In some patients it may be difficult to place the endotracheal tube which is another risk of general anesthesia.

With general anesthesia, since some of the medications will reach the baby directly through maternal blood, the baby’s respiration may be rarely supressed and may need some assistance with breathing after birth.