Epidural

What is an epidural?

An epidural is an injection into the space around your spinal nerves that’s used for pain management. This area is the epidural space. That’s where epidurals get their name.

Epidurals can be used to manage a variety of issues, including:

• Labor pain relief
• Before surgery, as an anesthetic
• Pain relief after surgery
• To treat back pain from issues like herniated disks
• Chronic pain management

Types of epidurals

There are two types of epidurals healthcare providers use for different situations:

• Epidural anesthesia. Anesthesia blocks feeling and pain. Epidural anesthesia is an injection of anesthetic medication into your epidural space.
• Epidural steroid injections (ESI). ESIs manage chronic pain and inflammation. A healthcare provider will inject a steroid (corticosteroid) into your epidural space. ESIs last longer than anesthetic epidurals. They manage pain for weeks or months.

How does an epidural work?

How an epidural works depends on which type you need.

An epidural anesthesia stops pain signals from traveling from your spinal nerves to your brain. It safely and temporarily turns off the nerves. How long the effect lasts depends on how much medication your healthcare provider gives you.

Epidural steroid injections coat the irritated nerves that are causing pain. This reduces swelling and pressure on your affected nerves.

There are a few ways your provider can inject medication with an epidural, including:

• Single-injection epidurals. These are one-time injections of either anesthesia or a steroid. This is how providers give most epidural steroid injections.
• Epidurals with a catheter. A catheter is a small, flexible tube that your provider will place into your epidural space. This lets them give you multiple doses of medication in the same place. These are most commonly used for anesthesia during longer surgeries and for labor pain relief.
• Epidural with a patient-controlled analgesia (PCA). These are special catheters your provider will leave in your epidural space after a surgery. You’ll be able to use a handheld device to control when you get pain medication. The pump will let you choose when to have safe, controlled doses of pain medication.
• Combined spinal-epidural (CSE). A CSE is a mix of both anesthesia and a steroid delivered through a catheter. CSEs are usually for labor pain relief. This type of epidural is often called a “walking” epidural, but most people aren’t able to fully walk. Instead, you’ll probably have some feeling in your lower body and be able to move or change positions.

How should I prepare for an epidural?

What you need to do ahead of time can vary depending on which type of epidural you’re getting and why you need it. Your healthcare provider will give you specific prep instructions.

In general, you might have to:

• Fast (avoid eating and drinking) for several hours before your procedure.
• Stop taking medications or over-the-counter supplements (especially if you take blood thinners).
• Plan ahead for someone to drive you home.

What happens during an epidural?

What happens during an epidural depends on which type you need.

If you need a single-injection epidural, you’ll lie face down (on your stomach). Your provider will:

1. Inject a small amount of local anesthetic to numb the area around where you need the epidural
2. Use fluoroscopy to guide them while they inject the epidural
3. Insert a needle into your epidural space near your affected nerves and inject the medication
4. Remove the needle and put a dressing and bandage over the injection site

If you need an epidural with a catheter, the procedure will be a little different. For these, your provider will:

1. Insert a port for intravenous (IV) fluids into a vein in your arm
2. Have you lie on your side or sit up with your chin tucked in toward your chest
3. Inject local anesthetic near the epidural site
4. Insert the epidural needle
5. Thread a catheter through the needle into your epidural space
6. Remove the needle, leaving the catheter in place
7. Begin injecting medication through the catheter
8. Remove the catheter once you no longer need medication (this might be several hours or days later)

What will I feel during my epidural procedure?

You’ll likely experience a minor pinch when your provider injects the local anesthetic to numb the area before the epidural procedure.

You may feel pressure, tingling, a burning sensation or momentary shooting pain when your provider injects the epidural. Or you may not feel anything. If you have any discomfort during the injection, it usually disappears once the injection is finished.

Tell your provider immediately if you feel intense, sharp pain during or after your epidural procedure.

What happens after an epidural?

Epidurals with anesthetic take 20 to 30 minutes to start working. Your provider will tell you what comes next if you’re having surgery or are in labor.

Epidural steroid injections start working in a few days. The pain relief should last a few months.

What are the benefits of having an epidural?

Epidurals are a safe, effective way to manage pain or give anesthesia.

Anesthetic epidurals are more flexible than other types of anesthesia, especially during labor. You can usually get an epidural any time during your labor if you need one. They often have milder side effects than other types of anesthesia.

Epidural steroid injections can help you resume daily activities that pain made you avoid. If it manages the pain well enough, you might avoid surgery or other invasive treatments.

What are the risks of getting an epidural?

Epidurals are usually safe, but there are risks of certain side effects and complications. Although rare, risks and complications can include:

• Bleeding at the injection site
• Cerebrospinal fluid leaks (this is very rare)
• Infections at the injection site
• Nerve damage that may lead to chronic pain
• Side effects or reactions to the anesthesia or steroid
• Spinal cord injuries

Can getting an epidural cause back problems?

There’s a common belief that getting an epidural will lead to back pain, but it’s very rare for an epidural to cause long-term or chronic back problems.

It’s normal to experience temporary back pain or tenderness at the site of your epidural. This usually goes away within a few days.

Many people who give birth experience back pain after labor and delivery — whether they’ve had an epidural or not. This is because the bones and ligaments in your pelvis shift back into their original positions from before your pregnancy. This can cause temporary back pain and discomfort.

How long does an epidural last?

How long the effects of an epidural last depends on which type you had and the exact medicine your healthcare provider injected. Your provider will let you know what to expect.

• Single-injection epidurals usually last a few hours before you regain feeling in the area that was numb. Epidural steroid injections usually manage pain for three to six months.
• Epidurals with a catheter typically make you feel numb for a few hours after your last dose before they wear off. You’ll probably have to rest without moving until you have full feeling in your legs again. You may feel a slight tingling sensation while you’re waiting.

When can I resume my normal activities?

Don’t drive, operate machinery or drink alcohol for at least 24 hours after having an epidural. You might have to avoid certain physical activities and exercises for a day or two after an epidural.

Your healthcare provider will give you specific instructions about when you can return to your usual routine.

When should I call my healthcare provider?

Call your healthcare provider or go to the emergency room if you experience any of the following symptoms after an epidural:

• Fever
• Losing control of your pee (urinary incontinence) or poop (fecal incontinence)
• Numbness and/or weakness in your legs that lasts longer than your provider says it should
• Severe headache while you’re standing up or sitting that feels better after lying down