Epidural Therapy Health Article

Definition

An epidural is a local (regional) anesthetic delivered through a small tube into a vacant space outside the spinal cord, the epidural space.

Purpose

The anesthetic agents that are infused through the small catheter block spinal nerve roots in the epidural space and the sympathetic nerve fibers adjacent to them. Epidural anesthesia can block most of the pain of labor and birth for vaginal and surgical deliveries. Epidural analgesia is also used after cesarean sections to help control post-operative pain.

Precautions

The primary problem associated with receiving epidural anesthesia is low blood pressure, otherwise known as hypotension, because of the blocking of sympathetic fibers in the epidural space. The decreased peripheral resistance that results in the circulatory system causes dilation of peripheral blood vessels. Fluid collects in the peripheral vasculature (vessels), simulating a condition that the body interprets as low fluid volume. A simple measure that prevents most hypotension is the infusion of 500-1000 cc of fluid intravenously into the patient prior to the procedure. Ringer's lactate, as opposed to a solution containing dextrose, is preferable because the elevated maternal glucose that accompanies the rapid infusion of solutions containing dextrose can result in hyperglycemia in the newborn with rebound hypoglycemia.

It is important not to place a woman flat on her back after receiving an epidural because the supine position can bring on hypotension. If a woman's blood pressure does drop, then the proper treatment is to turn her on her side, administer oxygen, increase the flow of intravenous fluids and possibly administer a medication such as ephedrine if the hypotension is severe. Very rarely, convulsions can result from severe reactions. Seizure activity would be treated with short-acting barbiturates or diazepam (Valium).

Description

Epidural anesthesia, because it virtually blocks all pain of labor and birth, is particularly helpful to women with such underlying medical problems as pregnancyinduced hypertension, heart disease, and pulmonary disease. Epidural anesthesia for labor is usually initiated at the woman's request, providing the labor is progressing well, or if the mother feels severe pain during early labor.