Every day, a large number of operations are performed in medical clinics. Surgical intervention is impossible without appropriate anesthesia, that is, anesthesia is necessary, otherwise it will be unbearable to endure such pain. There are many varieties of anesthesia. In the article we will understand what epidural anesthesia is, in what cases it can be used, whether there are contraindications.
What is epidural anesthesia?
This type of anesthesia is one of the methods of regional anesthesia. Epidural anesthesia is the introduction of drugs directly into the epidural space of the spinal column through a catheter. During such anesthesia, the following results can be achieved:
- Loss of pain sensitivity.
- The overall sensitivity decreases or practically disappears.
- Muscle relaxation.
The mechanism of action of epidural anesthesia is due to the fact that the drug penetrates through the dural couplings into the subarachnoid space, as a result of which the passage of nerve impulses is blocked.
The principle of action of epidural anesthesia
In humans, the spinal column and nerve endings on the neck are located in the dura mater. The epidural region is located around the membrane and runs along the spine. Nerves in the direction of the neck, arms and shoulders cross it, their inflammation leads to pain in the epidural region.
Medication injected into this area causes loss of sensation and dullness of pain. The transmission of nerve impulses is blocked, which gives such an effect.
When epidural anesthesia is used
Given that this type of anesthesia is used during surgery in various areas of the body, we can say that the risk of use may be greater or less. For example, epidural anesthesia of the chest, inguinal, legs and abdomen is less risky than analgesia in the neck and arms. The use of such anesthesia for the head is impossible, because the innervation of this part of the body is carried out using the cranial system.
Epidural anesthesia is most often used:
- As a local anesthetic, if surgery is not intended, for example, during labor.
- As an addition to general anesthesia, it is then possible to reduce the amount of opioids used.
- Epidural anesthesia is often used for caesarean section.
- In the postoperative period to relieve pain.
- For the treatment of back pain. In this case, steroid drugs and analgesics are introduced into the epidural region.
Which anesthesia is preferred, general anesthesia or epidural, the doctor decides in each case.
Methods of Epidural Anesthesia
Every year in the arsenal of doctors appears more and more new tools for the implementation of this type of pain relief. When doctors have a choice: general or epidural anesthesia, then, if possible, choose the latter. A large selection of drugs for its implementation allows you to choose the most suitable option for each patient.
In addition to a variety of drugs for anesthesia, there are various ways of such anesthesia:
- Continuous. In this case, the anesthetic is injected into the spinal space continuously. In this way, pain can be relieved for the entire period of the operation, and less medicine is needed.
- Intermittent administration The receipt of the drug is provided only when there is an urgent need for it.
- Anesthesia at the request of the patient. When using this method, the patient has a button under his hands. If there is a need for anesthesia, then when you click on it in the epidural region, part of the drug is supplied.
Doctors have such drugs that perfectly stop the pain syndrome, but retain mobility, and the mind is left clear.
In what cases is epidural anesthesia indicated
Most surgeons consider this method of anesthesia the most suitable during leg operations. It allows not only to relieve pain and relax muscles as much as possible, but also to reduce blood loss.
Indications for the use of epidural anesthesia can be of a different nature, for example:
- This method is absolutely safe for the kidneys and prostate gland.
- It is used for abdominal and pelvic organs.
- It is widely used during surgery on the stomach, intestines.
- It can be used for heart defects and diabetes.
But this does not mean at all that with such pathologies epidural anesthesia is always used. Everything is decided in each case individually.
Contraindications for use
Epidural anesthesia contraindications has the following: categorical and relative. The first category includes:
- The presence of tuberculous spondylitis or its complications.
- The inflammatory process on the back.
- Shock condition due to injury.
- In the presence of hypersensitivity to the drugs used.
- Pathology of the nervous system.
- If the spine is severely deformed.
- The process of blood coagulation is disturbed.
- There are serious diseases of the abdominal cavity.
- Intestinal obstruction.
Relative contraindications are much more extensive, these include:
- Excess weight.
- The poor state of the body.
- Chronic diseases of the spinal column.
- Childhood.
- Neurological diseases.
- Severe hypotension and many others.
The quality of epidural anesthesia will depend not only on the existing pathology and health status of the patient, but also on the drug that is supposed to be used.
Epidural Anesthesia for Caesarean Section
When there are all indications for caesarean section, then often instead of general anesthesia , epidural is used. This method is pre-selected, as it requires some preparation.
The introduction of the drug is carried out in a certain place at the level of the lower back, where the nerve endings exit the spinal cord. The drug is administered through a special catheter tube, during the operation, you can add medicine at any time.
As a result of such anesthesia, consciousness remains clear, and sensitivity below the waist disappears. A woman can see and hear doctors, but does not feel pain.
When there is a choice - epidural or general anesthesia for cesarean section - it is worth considering the indications and contraindications for anesthesia.
Indications for similar anesthesia
Most often, epidural anesthesia is used:
- If labor activity began ahead of time, for example, at 36-37 weeks. Such anesthesia relaxes the pelvic muscles, and the baby’s head experiences less stress while moving along the birth canal.
- Severe hypertension.
- Discoordination of labor, when various parts of the uterus contract with different intensities. Epidural anesthesia can reduce the intensity of contraction.
- With prolonged labor, when for a long time there is no complete relaxation. This can lead to birth abnormalities, so they use epidural anesthesia so that a woman regains strength.
Contraindications
In addition to the indications, in the case of a caesarean section, there are also contraindications for such anesthesia, these include:
- The presence of an inflammatory process at the puncture site.
- Infectious diseases.
- Allergic reaction to drugs.
- If there is a scar on the uterus.
- If the child is transverse or slanting.
- A narrow pelvis of a woman in childbirth.
- Big baby weight.
- If a woman herself does not want this type of anesthesia, then doctors can not use it against her will.
Before applying epidural anesthesia, the consequences, disadvantages and benefits must be considered.
Benefits of Epidural Anesthesia for Caesarean Section
The advantages of this type of anesthesia include:
- The woman is conscious throughout the operation; there is no risk of intubation or aspiration.
- There is no irritation of the upper respiratory tract, as with general anesthesia, which is especially preferred for patients with asthma.
- The cardiovascular system is stable, as the drug acts gradually.
- Preserved relative ability to make movements.
- Using such anesthesia, you can increase the time of anesthesia, since anesthetic is injected through the catheter at any time.
- After surgery, you can enter opioid drugs to relieve pain.
In addition to the advantages, it should be noted the shortcomings of such anesthesia.
Disadvantages of Epidural Anesthesia
Any method of surgical intervention, as well as anesthesia, has its drawbacks. The disadvantages of epidural analgesia include:
- An anesthetist’s mistake in administering the drug when the medicine enters the vessel. This can lead to convulsions, a sharp decrease in blood pressure.
- There is a danger of subarachnoid administration, as a result of which a total spinal block develops.
- To conduct such anesthesia, you must have a good skill, since this is the most difficult anesthesia.
- The drug begins to act only after 15-20 minutes, so surgery can not immediately begin.
- There is a risk of inadequate pain relief when the nerve endings are not completely blocked, and discomfort persists during the operation.
- It is necessary to carefully select drugs for such anesthesia during cesarean section, as some can penetrate the placenta and cause respiratory failure and fetal heart rate.
- After surgery, back pain, headache may be felt.
To make the right choice, if there is a
cesarean section, epidural or general anesthesia, you need to weigh the pros and cons. Take into account the existing contraindications and choose the most suitable type of anesthesia.
Complications of Epidural Anesthesia
Anesthesia gives epidural complications quite rarely, although such cases are found.
Most often noted:
- In 1 out of 20 patients, the drug does not fully function, and the nerve endings are not completely blocked, which means that analgesia will be ineffective.
- In the presence of coagulopathy, there is a risk of hematoma formation.
- Accidental damage during puncture of the dura mater can cause cerebrospinal fluid to leak into the epidural region. This is fraught with headache after surgery.
- A large dose of anesthetic may be toxic, which will result in an ineffective blockade.
- There may be side effects from the use of specific pain medications.
From all of the above, we can conclude that epidural anesthesia gives severe consequences for health in very rare cases.
Epidural Anesthesia Reviews
Each organism is individual, therefore, if some tolerate general anesthesia well, then for others epidural anesthesia is preferable. He has mostly good reviews.
Most patients note a good quality of pain relief, women during cesarean section can see all the actions of doctors and hear the cry of their baby immediately after his birth. There is a good opportunity to significantly reduce pain after surgery.
Many women in childbirth say that with high blood pressure, the use of epidural anesthesia allows keeping indicators within the normal range, which only positively affects labor activity.
But it also does not do without negative reviews. Some patients after such anesthesia feel a severe headache, back pain. There are those on which the drug simply did not work, and blockade of nerve endings did not occur.
Looking through all the reviews, only one conclusion can be drawn: any type of anesthesia requires a competent approach of a specialist. If even the simplest anesthesia is neglected, the dosage of the medicine is not calculated, then you can get undesirable consequences, sometimes even very serious ones, and what can we say about the epidural.
All questions must be discussed in advance with the doctor so that then there are no undesirable manifestations.
Of course, it would be perfectly ideal if no one needed surgical intervention, which means that anesthesia would not be needed. But our realities in life are such that sometimes operations cannot be avoided in order to preserve life and health. Take care of yourself and be healthy.