Regional Anesthesia & Pain Management (RAPM)

Patient Information

Epidural Pain Management
An epidural is a very small hollow plastic tube (catheter). It delivers pain medicine into your ‘epidural space,’ which is in your back. Your anesthesiologist will attach your epidural to a pump. The pump delivers small amounts of local anesthetic (freezing) and/or narcotic medications.

You might also be given a push-button that allows you to get extra pain medicine through the epidural up to every 20 minutes. Many women have an epidural for pain management during labor and delivery, and the same basic technique is used for acute pain management (although the medications may be different).

How is the epidural inserted?
The epidural is usually put in before your operation. You may be asked to sit with your arms crossed and your lower back pushed out toward the anesthesiologist. The skin is cleaned with iodine. After drapes are applied, the skin is injected with freezing medication. Then the epidural needle is inserted and the epidural space is located. When the needle is in the right position, the catheter is put in and the needle is removed. The catheter is taped to your back. It is then connected to a pump that will deliver pain medicine to help keep you comfortable after your operation.

What are the benefits of an epidural?
Epidurals provide better pain management for some surgeries (e.g. abdominal surgery and thoracic surgery) and patients are able to move easier and sooner with good pain management. Patients also experience less confusion and grogginess than with other techniques.

What are the risks with an epidural?
The anesthesiologist will talk to you about risks.

The most common serious risk is called a ‘wet-tap.’ It occurs in very few patients (perhaps less than one out of a hundred). A ‘wet-tap’ happens when the epidural needle encounters spinal fluid. If it happens to you, you may or may not get a ‘wet-tap’ headache. A ‘wet-tap’ headache is different from other headaches because it gets worse when you sit up. One of the best treatments is to take some of your blood and put it into the epidural space. This is called a ‘blood-patch.’

Other risks like allergic reactions, nerve damage, paraplegia, cardiac arrest, and infection are extremely rare.

What are the possible side effects from the medicine used in the epidural?
You may have temporary side effects from the local anesthetic medicine such as:

• Leg weakness and numbness
• Lightheadedness, dizziness, or nausea due to a drop in blood pressure. Your nurse will give you intravenous fluids to treat this.
• You might get backache. This is usually temporary and it might not be caused by the epidural.
• Back ache can also be caused by something like being in an awkward position during surgery

If morphine-type medications are used you might have side effects like nausea, vomiting, itch, and constipation.

Difficulty with urination is not usually a problem since most patients will have a small tube inserted to empty urine from their bladder after surgery

Can anyone have an epidural?
Not everyone should have an epidural. Some patients will benefit more than others. Your anesthesiologist will discuss this with you. At The University Health Network there is a team of anesthesiologists, anesthesia assistants, and nurses who work together put epidural catheters in place before you have your operation (see section on regional anesthesia).

How long do you use the epidural for?
The epidural is used for as long as you need it. This can be for two to three days. You may then be put on other kinds of pain control like oral medications or PCA.

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