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Is it possible before epidural anesthesia? When and how is epidural anesthesia done?

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Every woman is subconsciously afraid of labor pain. Despite preparatory stages, prenatal gymnastics and a good emotional mood, the feeling of fear and pain still haunts the woman until last moment. Very often, the expectant mother is negatively influenced by acquaintances or friends who like to talk colorfully about their childbirth and the consequences after it. You should try to avoid these “horror stories” and not allow the slightest fear. The calmer the woman in labor, the easier and faster everything goes.

Epidural anesthesia during childbirth comes to the aid of modern expectant mothers, which helps to simplify all the natural mechanisms of childbirth. With its help, a woman can more easily endure contractions and all labor pains, if all this becomes an unbearable burden for the woman in labor.

Epidural anesthesia - what is it?

Epidural anesthesia is aimed at action vertebral region, where special spinal roots with nerve impulses pass. All of them are related to the pelvic organs, including the uterus itself. When epidural anesthesia is administered, all these nerve impulses are blocked and do not transmit pain signals into the brain. Thus, the woman in labor ceases to experience painful sensations or they are felt to a minimal extent.

Often such anesthesia is aimed at easing contractions and giving the woman in labor a break before the birth itself. Doctors are very careful in calculating the dose to be given. This helps relieve pain without immobilizing the person. Women continue to be conscious and active even during childbirth.

Epidural anesthesia works primarily during dilatation of the cervix. Doctors try to carry out pushing and prenatal hours naturally so as not to negatively affect the health of mother and child.

How is spinal anesthesia different?

Spinal and epidural anesthesia are very similar in their effects on the body, only spinal anesthesia is injected deeper into the cerebrospinal fluid. This drug can act as an anesthetic in a completely different way and, naturally, a person’s reaction and behavior to pain with it is also different.

Spinal and epidural anesthesia differ only in the time frame and a deeper effect on the nerve endings. This drug is considered safer and gentler among doctors.

The prices for these drugs are approximately the same. If a woman gives birth in a regular maternity hospital, then this type of anesthesia should be provided free of charge. IN private clinic, for such a service they may require from 3 to 5 thousand rubles.

How is epidural anesthesia given?

If a woman in labor needs this anesthesia, she will have to go through a series of small steps to administer the drug. First of all, the woman is placed on her side, her back is slightly bent using the “curl” position, and an anesthetic is injected into the spine. Most often, the procedure is performed by several doctors so that the patient does not move unnecessarily and does not create additional problems.

Additionally, the site of the future puncture can be numbed and must be wiped with alcohol or some other antiseptic drug. To gradually deliver pain relief, an additional catheter can be inserted into the spine, which can carry labor pain throughout the entire process.

If, when a catheter is inserted, a woman begins to experience strong contractions, then it is best to abandon this option and not prevent the woman in labor from doing everything on her own. During the administration of the drug, various negative changes in the body may also occur. Nausea, dizziness, and numbness of the body are possible. If similar symptoms If they begin, you should immediately report them to your doctor.

The entire procedure of puncturing the spine and inserting a catheter into the body will take no more than 10 minutes by experienced doctors. Many expectant mothers, with trepidation and fear, begin to ask questions the day before: “does it hurt to have epidural anesthesia” or “does my back hurt after epidural anesthesia?” However, do not worry, the most unpleasant thing is to endure a few not entirely comfortable seconds during the puncture. All subsequent actions of doctors will simply not be noticeable by the body. The installed catheter will not interfere with the birth process and will not fall out of the back at the most crucial moment. Often the drug can be administered in different doses and at different time periods. All this directly depends on the condition of the woman in labor and her individual characteristics body.

Expectant mothers also should not worry about the entire process of labor with this drug. Nowadays, scientists have proven that such an anesthetic does not have time to penetrate through the placenta into the child’s blood. Thus, epidural anesthesia has no consequences for the child.

But epidural anesthesia during childbirth will have consequences for the mother herself. A woman cannot fully control her pain and her natural sensations during childbirth. Some doctors treat this drug with distrust, since the speed of cervical dilatation increases significantly, but the attempts themselves become weak and unnatural. Thus, the epidural technique may have little effect on the entire birth process and activities.

Indications and contraindications

The indications and contraindications for this anesthetic can be quite different. It all depends on the course of pregnancy and its complexity. Let's take a closer look at the cases in which a drug can have a positive or negative effect on labor and the future health of the mother in labor.

Indications:

It can be actively used in premature pregnancy. With the help of the drug, doctors cause active natural relaxation of all pelvic muscles and childbirth takes place in more gentle and natural conditions. Thus, the mother will not experience excessive pain due to the fact that her body did not have time to prepare for this process in advance.
Incorrect coordination of labor. At such a case the woman in labor experiences deep labor, but the uterus does not begin to contract or does so incorrectly. In this case, the drug can activate the muscles and help the uterus open naturally.
It is also actively used if a woman in labor has extremely high blood pressure. The drug helps to normalize and maintain blood pressure at the desired level during all stages of labor.
Unforeseen complications. Epidural anesthesia is necessary if the fetus is very large or if the pregnancy is multiple. Often the drug is also used if the expectant mother cannot use it for some reason general anesthesia.
You cannot do without this anesthetic even during very difficult or protracted labor. For example, Western clinics have been actively using this drug for quite some time now. for a long time so as not to torment women and create less for them painful sensations. However, our experts have a completely different opinion on this matter.

Epidural anesthesia has quite serious contraindications, which can significantly affect the health or life of the woman in labor.

Contraindications:

The drug is inadmissible for abnormally low blood pressure.
The woman in labor has any difficulties with the spine or it is unnaturally curved, which leads to difficulty inserting the catheter.
There are any inflammations on the back at the site of a possible puncture.
Allergy or intolerance to the drug.
Heavy bleeding during labor.
Mental disorders or unconsciousness women during childbirth.
Personal refusal of the woman in labor.
Weak blood vessels or heart disease.

Consequences and complications

In order not to deceive women, it is necessary to clearly explain to them all the risks that they may be exposed to. Such consequences occur quite rarely, but there is still a chance of getting such a problem. Epidural anesthesia primarily causes complications directly during childbirth.

The drug may accidentally enter the veins and spread throughout the body. Then the person is guaranteed weakness and general malaise. A woman may lose control of some limbs, have difficulty speaking, lose consciousness, or experience severe dizziness. Most often, if the drug enters a vein, these symptoms occur instantly. If the woman in labor feels them, she should immediately tell the anesthesiologist about it.

The drug may cause in some cases allergic reaction. If the doctors didn't know in advance possible reaction organism to this drug, it is even possible to develop anaphylactic shock. To avoid this, the woman is given minimal amount anesthesia to see how her body reacts.

“What else is dangerous about epidural anesthesia?” - you ask. Often, after using it, breathing difficulties may occur. Sometimes this is attributed to tension and efforts, but such difficulties have a slightly different nature. The anesthetic begins to actively influence the nerve endings and muscles that are located between the ribs.

In addition to difficulty breathing, severe headache and back pain may develop. Most often these unpleasant symptoms leave within a day after birth. But in the most severe cases this pain may last for several months. In this case, you need to treat it with medication under the supervision of a doctor. Sometimes doctors re-puncture and inject a large number of the patient's blood to “seal” the puncture inside the spine.

All symptoms related to dizziness, nausea or weakness also disappear a few days after birth. Sometimes for quick withdrawal After removing the anesthetic from the body, the mother is given a cleansing drip.
I don't want to scare all the expectant mothers who will have to undergo this anesthesia, but there is a very small chance of paralysis lower limbs.

Failed anesthesia

IN medical practice There are cases when, after the introduction of epidural anesthesia, a woman in labor does not feel any relief and painful symptoms don't retreat. According to statistics, 5 percent of women in labor feel no relief after anesthesia, and 15 percent of all women feel only slight relief.

The reason for such unsuccessful pain relief may be a large number of various factors. First of all, this is the individuality of the body, which reacts to the drug in its own way. Also, anesthesia is often administered outside of the Right place due to the inexperience of doctors or due to the fault of the woman in labor - if she moved too actively at the same time. The reason for an incorrect hit can be the excessive fatness of women or the curvature of the spine.

Advantages and disadvantages

If expectant mothers no longer have any unnecessary questions about the procedure and the effect of the drug on the body, let’s more accurately analyze and weigh all the pros and cons of epidural anesthesia.

Positive points:

the ability to make childbirth easier and make the process less traumatic and dangerous;
the opportunity to get some relief and respite for the process of giving birth;
possibility of preventing women from increasing blood pressure.

Minuses:

various complications of varying degrees of severity;
postpartum complications;
consequences after epidural anesthesia.

Thus, we really see that epidural anesthesia has its pros and cons. She is able to facilitate the process of childbirth in order for a woman to endure this difficult period in her life if the body does not have enough strength and health to do this on its own. Complications after epidural anesthesia can be removed and eliminated from the body through medical interventions as quickly as possible.

Theory of emotional contact with a child

Many people believe that administering additional anesthetics is wrong. Many mothers who have successfully overcome childbirth with anesthesia do not believe this theory, but it has many positive reviews.

During childbirth, mother and child are exposed to extreme stress. And if the mother is at least in a familiar environment, then the child learns new world. During this difficult moment in life, both loved ones must be connected to each other and general pain, which affects both mother and baby. This will allow them to maintain invisible emotional connection and during childbirth. Doctors recommend that mothers prepare themselves for an easy birth using other ways and methods, for example, going to special gymnastics, do breathing exercises, learn to relax and improve intercom with the baby. Many mothers “agree” with their child in advance so that everything goes well and without consequences. This attitude allows mothers to more easily survive all the torments and pains of birth.

In addition, any pain, and especially severe labor pain, produces great amount endorphin hormones, which are responsible for human happiness and pleasure. Thus, having gone through everything on her own without anesthesia, a woman can feel unprecedented joy and relief. And if there is no pain, then the woman will not experience joy.

Every mother must carefully weigh everything before giving birth and set herself up only for a positive result.

Useful video about epidural anesthesia

Reading time: 7 minutes

Every fifth woman in labor uses this type of pain relief in Russia, and in European countries 50% of women resort to it. Epidural anesthesia during childbirth (back puncture) is performed exclusively before the start of pushing, during painful contractions, since its function is to block pain, leaving the woman conscious. Despite the effectiveness of this method of pain relief, the epidural is a serious medical intervention, which has contraindications and can lead to serious complications.

What is epidural anesthesia

IN lumbar region spine, between the outer wall spinal canal and hard shell spinal cord spinal roots pass through, to which nerve impulses are transmitted from the pelvic organs, including the uterus. The introduction of an anesthetic blocks this process, due to which pain sensitivity women in labor is greatly reduced. Epidural anesthesia allows the woman to remain conscious; the doses of anesthetics are calculated so that the patient does not feel anything below the waist, but retains the ability to move. The period of pushing and childbirth passes without pain relief.

Effect on the fetus

Most experts believe that epidural pain relief used during childbirth does not affect the baby’s condition in any way. Injected anesthetics block nerve impulses, but do not enter the bloodstream and do not penetrate the placenta to the baby. However, if we take into account the fact that the baby during childbirth is exposed to no less stress than the mother and also experiences pain, then the use of pain relief for a woman is extremely undesirable.

The recommended refusal of anesthesia is due to the fact that painful sensations provoke the production of endorphin in the woman’s body (the baby’s body cannot produce it), after which the substance reaches the child. If the mother does not need the pleasure/happiness hormone, the body does not produce endorphin and the baby, who needs it during childbirth, is left without pain relief.

Pros and cons of the procedure

Childbirth with epidural anesthesia has its disadvantages and advantages. This method pain relief, compared to natural childbirth, has the following advantages:

epidural anesthesia provides an opportunity to avoid painful contractions and make the birth process more comfortable for the woman;
reduces the risk of increased blood pressure in women in labor with hypertension;
With the help of an epidural, you can relax and even sleep if labor is too long.

Pain relief during childbirth has the following disadvantages:

sharply reduces blood pressure in hypotensive patients;
carries a risk of complications to varying degrees heaviness;
The psycho-emotional connection between mother and child is lost.

Indications for epidural anesthesia during childbirth

Since the injection can lead to various complications and negative consequences, doctors try to do without it during childbirth. However, there are indications for which anesthetics are injected into the epidural space of the spine:

Premature pregnancy. The anesthesiologist injects an anesthetic to relax the mother's pelvic muscles, while the baby will experience less resistance as the baby passes through the birth canal.
Discoordination of labor. This condition occurs when there are contractions, but they do not bring the expected effect: the cervix does not dilate because the muscle contraction does not occur correctly.
Blood pressure is off the charts above normal. With the help of epidural anesthesia, blood pressure is normalized.
Long painful labor.
The need for surgical intervention. Indications for this may include multiple pregnancies, a baby that is too large, or the inability to administer general anesthesia during a cesarean section.

How to do the procedure

Epidural anesthesia for natural childbirth is carried out by a specialist anesthesiologist before pushing begins. How the manipulation is carried out:

The woman is in a sitting position, slightly rounding her back, or lying on her side, bending her legs under her. This way the doctor gets maximum access to the spine. In this position, the patient is asked not to move: a completely static body reduces the risk of complications.
The injection area is carefully treated antiseptic solution.
Next, a needle is inserted subcutaneously, through which an anesthetic (lidocaine) enters the body, reducing the sensitivity of the skin and subcutaneous fat at the site of catheter insertion.
The needle is inserted into the spinal space until the epidural catheter reaches the hard meninges. If a woman in labor feels an approaching contraction, she should definitely warn the anesthesiologist so that he stops (it is extremely important not to move during the procedure). You also need to notify a specialist if there are any changes in your health, be it numbness of the tongue, nausea, etc.
Through the catheter, the anesthetic enters the epidural space. The device remains in the back until the pain medication takes effect. In this case, the woman is allowed to move, but not abruptly.
The catheter is in the back of the woman in labor even during pushing, while the needle is removed and the remaining device is glued to the back with a plaster.
After delivery, the catheter is removed and the injection site is covered with adhesive tape. The woman should remain in a lying position for some time after this to minimize the risk of complications after epidural anesthesia.

Pain medications

In addition to the usual lidocaine, anesthesia during childbirth is carried out using many other drugs. These include:

Trimekain. The anesthetic begins to act 15 minutes after the injection, and the effect does not last longer than an hour. As a rule, Trimecaine is used together with anesthesia.
Dicaine. The drug begins to act after 20-30 minutes, while the duration of epidural anesthesia is about 3 hours. This time is enough to carry out most operations, including C-section. When using Dicain, it is important to carefully select the dosage, since even a minimal excess can lead to intoxication of the body.
Chloroprocaine. The drug blocks nerve impulses during childbirth for an hour after administration. Its action begins 15 minutes after epidural anesthesia.
Bupivacaine. You can feel its effect after 10-15 minutes, while pain relief lasts 5 hours. An epidural anesthesia drug is often used to improve a woman's condition and facilitate labor because it moderately relaxes the muscles of the uterus without inhibiting labor.

Complications of epidural anesthesia

According to reviews, in addition to pain relief, epidural anesthesia improves the birth process, making the woman in labor feel more comfortable and confident. However, maternity hospital staff do not recommend giving an injection unless there is a compelling reason due to the risk of complications during pregnancy and labor. Possible Negative consequences epidural anesthesia:

Getting anesthetics into the blood. There are many veins located in the epidural space, which poses a threat for medications to enter the bloodstream. In such cases, the woman feels dizziness, weakness, nausea, numbness of the tongue and bad taste in the mouth.
Allergy. Worst outcome in in this case- anaphylactic shock. To prevent the body from reacting to epidural anesthesia, the specialist first injects minimum dose drug.
Difficulty breathing. A rare complication that occurs due to the action of the anesthetic on the nerves going to the muscles of the ribs.
Pain in the back, head. The symptom occurs as a result of puncture of the dura mater and ingress of a small amount cerebrospinal fluid into the epidural space. The pain syndrome usually lasts for about a day after childbirth, but sometimes does not go away for months and is subject to drug treatment.
Severe decrease in blood pressure. This may result in vomiting, spots before the eyes, and nausea. A dropper placed after the puncture helps prevent complications of epidural anesthesia.
Decreased muscle tone Bladder. The complication leads to difficulty urinating.
Paralysis of the lower extremities. It happens extremely rarely with an unsuccessful injection.

Contraindications

Like other medical interventions, epidural anesthesia during childbirth has a number of contraindications. These include:

intolerance to drugs for epidural anesthesia;
blood pressure problems (hypotension or hypertension);
inflammation in the area of the intended puncture;
curvature of the spine, difficult access for catheter insertion;
some pathologies of blood vessels, heart;
bleeding disorders, blood poisoning;
the presence of psychoneurotic diseases or the woman’s unconscious state;
risk of obstetric hemorrhage.

Cost of epidural anesthesia during childbirth

If there is an indication for pain relief, the injection is given in the maternity hospital free of charge. If a woman decides to give birth with epidural anesthesia, the price in Moscow government agencies is this procedure ranges from 3,000-5,000 rubles; in private clinics, an injection costs an average of 10,000-15,000 rubles. In St. Petersburg, the cost of epidural anesthesia during childbirth ranges from 5,000 to 13,000 rubles.

Video

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

Probably, all first-time expectant mothers, without exception, are frightened by the upcoming birth. A significant portion of the horror stories that friends share and online forums are full of are stories about how painful contractions and childbirth itself are.

Of course, it is unlikely that the sensations that a woman experiences during labor can be called pleasant, but they are the ones that help to truly understand and realize the birth of a new life. However, today it is possible to bypass natural mechanisms and significantly simplify the life of a woman in labor by using epidural anesthesia during childbirth.

In the lumbar region of the spine, in the epidural space (inside the spinal canal, between its outer wall and the hard shell of the spinal cord), the spinal roots emerge. It is through them that the transmission occurs nerve impulses from the pelvic organs, including the uterus.

Injected painkillers block transmission pain impulses to the brain, thereby allowing the laboring woman not to feel contractions. However, the dose is calculated so that the woman in labor does not feel anything below the waist, but can move independently. Epidural anesthesia during childbirth allows the woman to remain fully conscious.

It is worth noting that the effect of epidural anesthesia, if not special indications, applies only to contractions during cervical dilatation. The woman goes through the period of pushing and the birth itself without pain relief.

Epidural and spinal anesthesia: what is the difference?

Sometimes these two types of anesthesia are confused, which is not surprising, since they are very similar in appearance. Difference spinal anesthesia in that a sharper needle is used, and the anesthetic is injected into the cerebrospinal fluid below the level of the spinal cord, therefore, the mechanism of action of the drugs is somewhat different than with epidural anesthesia. In addition, the latter is considered safer in terms of complications.

Price

If anesthesia is carried out according to medical indications, then they do it for free. In the case when a woman herself decides to give birth with epidural anesthesia, the price of this manipulation will be about 3,000-5,000 rubles, depending on the maternity hospital.

How do they do it?

1. To carry out a puncture, a woman needs to sit down with her back bent, or lie on her side and curl up. In other words, ensure maximum access to the spine. Moreover, you need to try very hard not to move at all - freeze in the position determined by the anesthesiologist and be prepared for the fact that you will feel some short-term discomfort(at this moment it is important not to distance yourself from the doctor). The more still you are, the lower the risk of complications after epidural anesthesia.

2. The puncture area is carefully treated with an antiseptic solution.

3. A regular injection of an anesthetic is given in order to relieve the sensitivity of the skin and subcutaneous fat at the site of the upcoming puncture.

4. The anesthesiologist makes a puncture and inserts a needle into the epidural space of the spine until it reaches the dura mater.

If you feel that a contraction is about to begin during the manipulation, be sure to inform the anesthesiologist about this, he will stop. Remember: yours the main task- do not move!

Also tell your anesthesiologist if you feel any changes in your condition. This may be: a feeling of numbness in the legs or tongue, dizziness, nausea, etc. Normally, nothing like this should happen, and if something goes wrong, you need to immediately inform the doctor about it, since it is easiest to correct the situation at this stage.

5. A thin silicone tube - a catheter - is passed through the needle, through which painkillers enter the epidural space. The catheter remains in the back as long as the analgesic effect is needed. With it, a woman can move freely, but sudden movements should be avoided. During the birth itself, the catheter will also be in the back of the woman in labor.

As the catheter is inserted, you may feel a shooting sensation in your leg or back. This is normal - it means the tube has touched a nerve root.

6. The needle is removed and the catheter tube is secured to the back using adhesive tape.

7. A test injection of a small amount of anesthesia is carried out to check for inappropriate reactions body.

8. After childbirth, the catheter is removed from the happy mother’s back, the puncture site is sealed with an adhesive plaster and the woman is recommended to remain in a lying position for some time, this is necessary to minimize the risk possible complications after epidural anesthesia.

Puncture and installation of the catheter takes about 10 minutes. The drugs usually begin to work within 20 minutes after administration. Many women are frightened by the possibility of spinal manipulation; as a rule, everyone wonders whether epidural anesthesia is painful. We hasten to reassure you, the woman in labor will feel quite tolerable discomfort that will last only a few seconds. Subsequently, even with movement, the catheter is not felt.

The administration of painkillers is possible in two modes:

continuously, at short intervals - in small doses;
once, repeating if necessary after 2 hours - while the drugs are working, the woman is recommended to lie down, since the vessels of the legs dilate, and the outflow of blood to them can lead to loss of consciousness if the woman in labor gets up.

What drugs are used for epidural anesthesia?

Drugs that are not able to cross the placenta are usually used: Lidocaine, Bupivacaine, Novocaine.

Does epidural anesthesia affect the baby's health and labor?

On this moment Most experts believe that epidurals used during childbirth have no effect on the baby. Injected anesthetics do not penetrate the placenta and are not absorbed into the baby’s blood.

As for labor, opinions differ. Some practicing anesthesiologists claim that anesthesia has no effect on the course of labor, including the speed of dilatation, while others say that the speed of the first stage of labor (dilatation of the cervix) increases, but pushing becomes less pronounced. In any case, if anesthesia affects labor, it is insignificant.

Indications for use

Premature pregnancy. In this case, with the help of epidural anesthesia during childbirth, the mother's pelvic muscles relax. This means that the baby will experience less resistance as it passes through the birth canal.
Discoordination of labor. This phenomenon occurs when contractions occur, but do not bring the desired effect: the muscles of the uterus contract incorrectly, not at the same time, and the cervix does not dilate.
Blood pressure is higher than normal. Anesthesia helps reduce and normalize blood pressure levels.
The need for surgical intervention(multiple pregnancy, too big baby) or the inability to perform general anesthesia.
Long and painful labor.

In Western clinics, epidural anesthesia during childbirth is often performed without indications, simply so that the woman giving birth experiences as little discomfort as possible. However, the opinions of experts on this matter are diametrically opposed.

Contraindications

Like any medical intervention, epidural anesthesia during childbirth has a number of contraindications:

pressure abnormalities: low arterial or elevated cranial;
spinal deformity and difficult access for catheter insertion;
inflammation in the area of potential puncture;
a bleeding disorder, low platelet count, or blood poisoning;
possibility of obstetric hemorrhage;
drug intolerance;
psychoneurological diseases or unconsciousness of the woman in labor;
some heart or vascular diseases; in this case, the possibility of epidural anesthesia is considered individually;
refusal of the woman in labor to receive pain relief.

Consequences and complications after epidural anesthesia during childbirth

Entry of anesthetics into the venous bed. There are quite a few veins in the epidural space, which poses a threat of drugs entering the bloodstream. If this happens, the woman will feel weakness, dizziness, nausea, an unusual taste in the mouth, and numbness of the tongue. We wrote about this above and have already said that if any deviations in health occur, it is necessary to urgently inform the anesthesiologist.

Allergic reactions. If a woman has not encountered various anesthetics (painkillers) before giving birth, then during anesthesia it may become clear that she is predisposed to an allergy to a particular drug, which in turn is fraught with the development of anaphylactic shock (impaired vital systems and organs). In order to exclude severe attack allergies, a minimal proportion of anesthetics is first administered.

Quite rare, but occurring, complications after epidural anesthesia include: difficulty breathing. The complication occurs as a result of the effect of anesthetics on the nerves going to the intercostal muscles.

Headache and back pain. Sometimes women complain that their back hurts after epidural anesthesia. Pain occurs as a result of the needle puncturing the dura mater and allowing some cerebrospinal fluid to enter the epidural space. Back pain after anesthesia usually develops within 24 hours, but there are cases when it lasts for months, the same can be said for headaches. This complication is usually treated by medication or by repeating the puncture and injecting a small amount of the woman’s own blood into the “leak” site to seal the puncture.

Drop in blood pressure level, and, as a result, “spots” in the eyes, sudden attack nausea or vomiting. To prevent this consequence of using epidural anesthesia during childbirth, a drip is usually placed and it is recommended to lie down for some time after the puncture and installation of the catheter.

Hypotonicity of muscles bladder and difficulty urinating.

What else is dangerous about epidural anesthesia? I would not like to scare expectant mothers who are waiting for epidural anesthesia during childbirth, but it is still necessary to mention that very rarely complications arise after anesthesia, such as paralysis lower limbs.

Failed epidural anesthesia

If you believe the statistics, then in 5% of cases of using epidural anesthesia during childbirth, pain relief does not occur at all, and in 15% it occurs partially.

Why is this happening? Firstly, it is not always possible to get into the epidural space. The reason for this may be the inexperience of the anesthesiologist (although usually young doctors carry out manipulations in the presence of more experienced colleagues), excessive obesity of the woman in labor, or anomalies spinal column.

Secondly, a woman may not feel pain on the right or left. So-called mosaic anesthesia occurs if the connecting septa in the epidural space prevent the spread of anesthetics. In this case, you need to inform the anesthesiologist, he will increase the concentration of the drugs, advise you to turn on the side where the anesthesia did not work, or make another puncture.

Epidural anesthesia: pros and cons

So, if you have neither indications nor contraindications for epidural anesthesia during childbirth, and you are considering this option in order to make the arrival of your long-awaited baby more comfortable, carefully weigh all the positive and negative aspects.

It should be clarified that we are not considering the advantages and disadvantages of epidural anesthesia during childbirth compared to other types of pain relief, but will try to analyze it in relation to natural birth without drug intervention.

The benefits of epidural anesthesia

the ability to relieve pain during labor and make the birth process as comfortable as possible for the mother;
the opportunity to “take a break”, rest or even sleep if childbirth lasts a very long time;
Reducing the risk of increased blood pressure in women suffering from hypertension.

Disadvantages of epidural anesthesia

risk of complications of varying severity
a sharp drop in blood pressure in hypotensive women;
loss of psycho-emotional contact with the child; This point causes a lot of controversy - often mothers who had a successful birth using epidural anesthesia treat such statements with a good dose of cynicism, but let's try to look at it from the outside.

During childbirth, not only the mother experiences enormous stress, but at least she is in familiar conditions, but the baby has to master a completely new world. It’s not for nothing that the passage of a child through the birth canal is called “expulsion.” The baby is subject to extreme stress, preparing for and leaving the very safe place, abruptly plunging into a completely unfamiliar and largely hostile environment.

When both mother and baby experience pain, it binds and unites them more strongly. Probably, any mother whose child was sick would happily share his suffering, because for her it is unbearable to look at the suffering of her baby from the outside.

The same thing happens during childbirth, although we do not see the state in which the child is about to be born, this is not a reason to throw him alone into such a situation. Hard time. Better prepare for childbirth, learn techniques correct breathing and relaxation, and try to help not only yourself, but also the child in a natural way.

In addition, it is known that pain provokes the release of endorphin - the hormone of happiness and pleasure. In newborns, the production of this hormone is not possible, so during childbirth they receive it from the mother. And if the mother does not feel pain, then there is no need for the hormone - the woman’s body does not produce it either for herself or for the child, who still needs it.

So, if epidural anesthesia is indicated for a woman, then there is no point in talking about the advisability of its use. If a woman literally “goes crazy” from unbearable pain (this usually happens if some obvious or implicit complications have arisen), then pain relief is also a necessity.

However, if normal flow nothing prevents future mom should carefully weigh the pros and cons of using epidural anesthesia during childbirth.

Perhaps it is worth going through the process determined by nature in order to feel real unity with the child, fully share the miracle of birth with him, and, in the end, completely eliminate the risks associated with drug intervention in such a delicate system as the spine.

Video of how to place an epidural

Replies

Before we move on to explaining the mechanism of action of the anesthetic effect, let’s figure out why anesthesia exists at all. For the first time, anesthesia was administered purposefully, as medical supplement applied famous doctor Pirogov, having undergone general ether anesthesia.

Before this, people were simply given alcohol to the point of unconsciousness or given in large doses narcotic substances such as hashish or opium. Both had serious consequences for the patient. It is fundamentally incorrect to call anesthesia anesthesia, because its task is, first of all, to ensure the vital activity of the body during any intervention in the human body aimed at eliminating injuries, relieving pain and recovery.

Are there complications after anesthesia?

But anesthesia is not a panacea, since freeing the body from stress and painful shock, can itself cause harm and cause complications if the dosage is incorrect.

Everyone is familiar with the contract that is signed in medical institution when the operation is planned. It contains a clause clearly indicating that the institution does not take responsibility for the consequences of anesthesia. The anesthesiologist always first finds out during the interview whether the patient has an individual intolerance to any drugs, the frequency of operations, former diseases; A cardiogram and all tests are required; talks about the reaction that can occur after anesthesia. Even u have enough healthy person discomfort or complications may occur. Coming to consciousness in the postoperative unit, almost every patient feels unwell.

Symptoms of anesthesia transfer are:

general weakness;
nausea or vomiting;
pain in the head and muscles;
sore throat and confusion;
severe drowsiness and sweating.

It is less common for a patient to regain consciousness during surgery. In this case, complications of anesthesia may include injuries to the lips and tongue, bronchopulmonary infections.

Isolated cases after anesthesia are injuries nerve endings, eyeballs or their injury, reactions such as anaphylactic shock and death of brain cells.

Many side effects can be avoided if you strictly follow the doctors' recommendations - once you regain consciousness after surgery, you cannot drink (this will cause vomiting), nausea can be relieved by moistening your lips in acidified lemon water. A sore throat goes away on the second day at most. Chills are also not dangerous, since they last no more than half an hour; it is enough to cover the patient with a warm blanket.

How does epidural anesthesia work?

Epidural anesthesia - administration of painkillers medical supplies into the epidural space of the spinal canal through a special catheter. This type anesthesia is regional, because medications have an effect only on certain groups of nerves and block the transmission of pain impulses through them to the cerebral cortex.

How long does epidural anesthesia last?

The duration of action of spinal anesthesia is limited by the duration of action local anesthetic, which is given by injection, and lasts approximately one to four hours. But epidural anesthesia is not limited in time and it lasts as long as the local anesthetic is administered through the catheter. This is very convenient and allows you not only to anesthetize the operation, but also to relieve the patient from pain in the postoperative period.

Epidural anesthesia is currently gaining increasing popularity among doctors and patients. And for good reason: this procedure gives good efficiency and has quite a few contraindications.

Epidural anesthesia is considered modern method in medical practice, but it has been known about it for a long time. At the beginning of the twentieth century, experts discovered that if cocaine is injected into the epidural space, an excellent analgesic effect is observed. But, despite such important scientific discovery, anesthesia for many reasons was not widely used in medicine. For about a century in the post-Soviet space, many doctors continued to use “general anesthesia,” while ignoring for a long time the more gentle and easy method pain relief.

At the moment, we can safely count on epidural (synonymous with epidural) pain relief, which is widely used in abdominal surgery, oncology, traumatology and orthopedics, obstetrics, gynecology, urology and quite often in pediatrics. So, let's find out and consider what epidural anesthesia is, how this procedure is performed, and what it has side effects, does it hurt and why this particular anesthesia and not general?

Today this method is considered the most common in anesthesiology. How many patients choose this? modern look pain relief, like an epidural?

If you believe the statistics, then developed countries Europe and the USA use it in 75-80% of cases.

Execution technique

The most important task for the anesthesiologist is to correctly place the catheter in the epidural (epidural) space. Below the epidural space is the spinal cord, which is also surrounded by a membrane (it is in this place that a needle must be inserted to obtain anesthesia such as spinal anesthesia).

Epidural anesthesia is carried out using a special needle (Tuohy needle), which has a certain diameter (1-2 mm) and length (9 cm). The local anesthetic, entering the epidural space, blocks conductive nerve fibers, which are directly connected to the spinal cord. Thus, epidural anesthesia occurs in one or another area of the body, depending on the level of anesthesia.

Tuohy needle

To perform a pain-relieving procedure, you must have an epidural kit that includes the following (additional items may be included):

Tuohy needle (epidural needle);
epidural catheter;
low resistance syringe;
connector
bacterial filter;

1-Tuhy needle. 2-connector with catheter. 3-bacteria filter. 4-syringe low resistance

How is epidural anesthesia given?

The manipulation is performed by an anesthesiologist and nurse. Before starting the procedure, the epidural anesthesia kit is laid out in a sterile tray or on a sterile diaper.

The patient is in a sitting position, although a side position with legs bent to the chest is also allowed. The patient is asked to arch his back or “cat” in order to more conveniently find the necessary landmarks and get the needle into required area. In this case, the doctor recommends that the patient not make any movements in order to perform his work correctly and quickly.

The location of the catheter depends on the surgical procedure (operation). This is most often the lumbar, lower thoracic or high thoracic levels. The doctor’s task at this stage is to use the palpation method (touch with hands) to select the required place where the needle will be inserted.

The injection site is covered with sterile material (diapers, sheets, disposable aprons), only a small window is left in the spine area, which is then treated with an antiseptic. Or simply the back is widely treated with an antiseptic solution. It all depends on financial capabilities medical institution. Since the procedure can cause pain to the patient, the area is first “frozen” - the desired area is injected with a local anesthetic (most often lidocaine). The patient may report that there is a slight swelling in the injection area and may feel a slight burning sensation that does not last long. The doctor then begins to “search” for the desired space using a Tuohy needle and syringe low pressure, and installation of an epidural catheter in this space

This stage of manipulation is considered the most important and painless for the patient: under the influence of previous anesthesia, the needle puncture is, as a rule, practically not felt or not felt at all. Correct technique It requires great medical skill to successfully carry out a procedure such as epidural anesthesia.

When the needle has reached the required area, a catheter is inserted through it. Through this thin tube the drug will be supplied to perform anesthetic effect. The patient at this stage also does not feel any discomfort.

After installing the catheter into the spine, the needle is removed. Next, a connector (adapter) is connected to it so that the required drug can be administered with a syringe.

Before administering the full dose of anesthetic, the doctor administers a “test dose.” This is one of additional methods for confirmation correct location epidural catheter. To do this, a few milliliters of the drug are injected and its effect is assessed. At this time, the doctor will ask questions and ask you to perform certain actions. It is very important that the patient gives clear answers and follows all the doctor’s actions exactly. The quality of anesthesia will depend on this. The catheter is securely fixed using a sterile dressing and adhesive tape. Many patients ask: “How long does it take before I feel the effects of the medicine and the anesthesia?” The effect of anesthesia appears after 15-25 minutes.

Indications for epidural anesthesia:

execution surgical interventions on chest cavity, abdominal cavity, on the lower extremities;
V complex therapy certain diseases (for example, pancreatitis)
treatment of chronic and persistent pain;
labor pain relief;
obstetric indications;

Contraindications to peridural (epidural) anesthesia.

So, contraindications can be absolute (the patient is not allowed to undergo anesthesia in 100% of cases) or relative (at the discretion of the doctor).

Absolute contraindications:

patient refusal;
skin diseases of the back with pronounced pustular abscesses and formations at the puncture site (injection);
allergic reaction to local anesthetic;
severe deformation of the spinal column (for example, Bechterov's disease);
impaired blood clotting function (coagulopathy);
Clinically significant hypovolemia (dehydration, blood loss);
Cardiac conduction disturbances (AV block, sick sinus syndrome);

Relative contraindications:

developmental anomalies and mild deformity of the spine;
psychiatric diseases;
Low level of intelligence in the patient;
Treatment with antiplatelet agents and anticoagulants - blood thinning drugs (clopidogrel and its derivatives, warfarin, etc.);
Transferred early surgery on the spine;
Presence of a tattoo at the puncture site (injection);

Pros and cons of anesthesia

As mentioned above, epidural anesthesia is highly relevant today. This type of anesthesia has much less side effects on the body, unlike general anesthesia(anesthesia)

However, each medal has back side. It's about about complications

Complications of epidural anesthesia:

epidural anesthesia does not bring the desired effect, so it can be observed partial blockade or it will not exist at all (pain relief will not occur);
the formation of a hematoma in the epidural space is a fairly rare complication;
infection in the epidural space is rare;
toxic effect of drugs due to unintentional intravenous administration of a local anesthetic or drug overdose due to an exceeded dose of the drug;
Headaches of varying intensity. This can occur when the spinal space is inadvertently punctured with a Tuohy needle (the most common complication).
Various neurological disorders– from mild (partial paralysis/numbness, leg pain) to severe (spinal cord damage) – very rare;
Catheter rupture (since the catheter is a plastic tube, it could hypothetically break! Depending on the level at which the catheter broke off, it may be necessary surgery upon his "capture". For example, if it happened at the skin level. In other cases, the catheter is left in place, as it is absolutely compatible with the surrounding tissues);
Back pain (most often due to the fact that anesthesia causes relaxation of muscles and tension of ligaments, occurs in approximately 40% of patients, disappears after 1-2 days, cases of longer-term presence of pain are described, which is associated with exacerbation of existing problems with the spine) ;
Incorrect administration of a product not intended for epidural administration medicine(no matter how strange it may sound, this does happen, although quite rarely)