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Epidurals for Pain Relief

In This Article:

Epidural side effects and problems

Side effects

There are a number of minor side effects. The medication can cause blood pressure to fall, so this will be monitored (see How an epidural is done). If it does fall, you'll be given fluids and medication, and subsequent doses may be reduced.

It's common to experience itching with epidurals, caused by the release of histamine from the opioid component of a mobile epidural. Histamine is a substance released by the body during an allergic reaction that can cause itching. The itch can be treated, but in most cases it gets better on its own. If you develop an itch, a greater concentration of local anesthetic alone will be used.

It's not unusual to shiver with an epidural, although this is a more common side effect if a concentrated local anesthetic is used, as is the case for a cesarean delivery.

Epidural pain relief can cause a rise in temperature. If this occurs, you'll have a blood test to eliminate an infection since this can also cause your temperature to rise. You will be given preventative antibiotics while waiting for the blood test results, and acetaminophen to bring your temperature back to normal.

Problems with epidurals

In addition to side effects, there can occasionally be problems with the effectiveness of an epidural. The anesthetic may not spread evenly in the epidural space, which may be caused by the epidural tube sitting on one side of the epidural space. This can mean that pain relief only occurs on one side of the body. If this occurs, the anesthesiologist will try to reposition the tube and give another dose of anesthetic. If this doesn't work, the only other solution is to redo the entire epidural.

Sometimes, one spot can remain painful, usually in the groin area or low down in the front of the abdomen, which is referred to as a "missed segment." This results from a single nerve root not being coated with the local anesthetic. Again, the anesthesiologist may reposition the tube. Sometimes, a stronger local anesthetic or an opioid is used to numb the area. If a persistent missed segment is too uncomfortable, the anesthesiologist may do a combined spinal epidural block, known as a CSE.

It's thought that epidural pain relief may prolong the second stage of labor. It also increases your chances of having an assisted delivery, especially if a high dose of anesthetic is given toward the end of labor, which affects your ability to push. However, an epidural doesn't increase the chance of a cesarean and doesn't, despite common misconceptions, cause long-term backache after the birth.

An epidural "headache"

Some women report a headache after an epidural, which can develop more than 24 hours after the delivery and tends to be at the front of the head. It is made worse by sitting up and moving around and is much improved by lying down. This occurs in around 1 in 100 women and is caused by the epidural needle moving too far forward and cutting the dura sheath, the membrane maintaining the fluid around the spinal cord and brain. This small hole results in a loss of fluid from the sheath, which causes a headache. The risk is hugely reduced by remaining still during the placement of the epidural. In around 70 percent of women, the hole heals on its own. You will be advised to drink plenty of fluids and to take simple painkillers, such as acetaminophen and ibuprofen and you will be reviewed at regular intervals by an anesthesiologist.

If the headache persists, a procedure called a "blood patch" will be done. This is done in the sterile environment of an operating room by two anesthesiologists. One places an epidural needle in your back, while the other takes around 20 ml of blood from a vein in your arm. The blood is then passed down the needle into the epidural space. This forms a clot that seals the hole and prevents further leakage of fluid from around your spine, therefore relieving the headache.

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Excerpted from Pregnancy Day by Day.
Copyright © 2008 Dorling Kindersley Limited.
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