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 simply unbearable to endure such pain. There are many types 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. In the course of such anesthesia, the following results can be achieved:
- Loss of pain sensitivity.
- Reduces or almost disappears the overall sensitivity.
- Relaxing muscles.
The mechanism of action of epidural anesthesia is due to the fact that the drug penetrates through the dural couplings into the subarachnoid space, resulting in blocking the passage of nerve impulses.
The principle of action of epidural anesthesia
In humans, the spinal column and nerve endings in the neck are located in the dura mater. The epidural region is located around the shell 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.
Medicine injected into this area causes loss of sensation and dulling of pain. The transmission of nerve impulses is blocked, which gives such an effect.
When an epidural 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 lesser. For example, epidural anesthesia of the chest, groin, 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 most commonly used:
- As a local anesthetic when surgery is not expected, such as during labor.
- As an adjunct to general anesthesia, then the amount of opioids used can be reduced.
- Epidural anesthesia is often usedfor caesarean section.
- In the postoperative period to relieve pain.
- For the treatment of back pain. In this case, steroids and analgesics are injected into the epidural area.
Which kind of anesthesia to give preference to, general anesthesia or epidural, the doctor decides in each case.
Methods of epidural anesthesia
Every year in the arsenal of doctors there are 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, they 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 the 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, you can achieve pain relief for the entire period of the operation, and less medication will be required.
- Periodic introduction. The supply of the drug is provided only when there is an urgent need for it.
- Pain relief 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 press it, part of the drug is supplied to the epidural region.
Doctors have drugs that perfectly relieve pain, but retain mobility, and leave consciousness clear.
In what cases epidural anesthesia is indicated
Most surgeons consider this method of anesthesia to be the most appropriate during operations on the legs. It allows not only to relieve pain and relax the muscles as much as possible, but also to reduce blood loss.
Indications for epidural anesthesia may vary, for example:
- This method is absolutely safe for the kidneys and prostate.
- Used for abdominal and pelvic organs.
- Widely used during surgery on the stomach, intestines.
- Can be used for heart defects and diabetes.
But this does not mean at all that epidural anesthesia is always used for such pathologies. Everything is decided in each case individually.
Contraindications for use
Epidural anesthesia has the following contraindications: categorical and relative. The first category includes:
- Presence of tuberculous spondylitis or its complications.
- Inflammatory process on the back.
- Shock from injury.
- If there is hypersensitivity to the drugs used.
- Pathologies of the nervous system.
- If the spine is severely deformed.
- Impaired blood clotting.
- There are serious diseases of the intra-abdominal cavity.
- Intestinal obstruction.
Relative contraindications are muchmore extensive, these include:
- Overweight.
- Poor body condition.
- Chronic diseases of the spinal column.
- Children's age.
- Neurological diseases.
- Severe hypotension and many others.
The quality of epidural anesthesia will depend not only on the existing pathology and the patient's he alth, but also on the drug that is supposed to be used.
Epidural anesthesia for caesarean section
When there are all indications for a caesarean section, epidural anesthesia is often used instead of general anesthesia. This method is chosen in advance as it requires some preparation.
The drug is injected into a certain place at the level of the lower back, where the nerve endings come out of the spinal cord. The drug is administered through a special tube-catheter, during the operation, you can add medicine at any time.
As a result of such anesthesia, the consciousness remains clear, and the sensitivity below the belt disappears. The woman can see and hear the doctors, but feels no pain.
When there is a choice - epidural or general anesthesia for caesarean section - it is worth considering the indications and contraindications for anesthesia.
Indications for such anesthesia
The most commonly used epidural anesthesia is:
- If labor activity began ahead of time, for example, at 36-37 weeks. Such anesthesia relaxes the pelvic muscles, and the child's head experiences less stress duringadvancement through the birth canal.
- Severe hypertension.
- Discoordination of labor, when different parts of the uterus contract with different intensity. Epidural anesthesia allows you to weaken the intensity of the contraction.
- With prolonged labor, when there is no complete relaxation for a long time. This can lead to birth abnormalities, so epidural anesthesia is used to give the woman 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 baby is in a transverse or oblique position.
- Narrow pelvis of the woman in labor.
- Heavy weight baby.
- If the woman herself does not want this type of anesthesia, then doctors cannot use it against her will.
Before using epidural anesthesia, the consequences, disadvantages and advantages 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.
- No upper respiratory tract irritation as withgeneral anesthesia, which is especially preferable for patients with asthma.
- The cardiovascular system works stably, as the drug acts gradually.
- Relative movement ability retained.
- With the help of such anesthesia, you can increase the time of pain relief, since the anesthetic is injected through the catheter at any time.
- After surgery, opioids can be administered to relieve pain.
In addition to the advantages, it is necessary to note the shortcomings of such anesthesia.
Disadvantages of epidural anesthesia
Any method of surgery, as well as anesthesia, has its drawbacks. The disadvantages of epidural anesthesia include:
- An anesthesiologist's mistake when administering the drug, when the drug enters the vessel. This can lead to convulsions, a sharp drop in blood pressure.
- There is a risk of subarachnoid insertion resulting in total spinal block.
- To perform such anesthesia, you need to have a good skill, as this anesthesia is the most difficult.
- The drug begins to act only after 15-20 minutes, so surgery cannot be started immediately.
- There is a risk of inadequate pain relief when the nerve endings are not completely blocked, and discomfort persists during the operation.
- Careful selection of drugs for such anesthesia during caesarean section is necessary, as some can cross the placenta and cause respiratory and heart rhythm disturbancesfetus.
- After surgery, you may feel back pain, headache.
To make the right choice, if you have a caesarean section, epidural or general anesthesia, you need to weigh the pros and cons. Consider the available contraindications and choose the most appropriate type of anesthesia.
Complications of epidural anesthesia
Anesthesia epidural complications are quite rare, although such cases do occur.
Most celebrated:
- In 1 out of 20 patients, the drug does not fully work, and the nerve endings are not completely blocked, which means that pain relief will be ineffective.
- In the presence of coagulopathy, there is a risk of hematoma formation.
- Inadvertent injury during puncture of the dura mater can lead to leakage of cerebrospinal fluid into the epidural area. This is fraught with headache after surgery.
- A large dose of pain medication can be toxic, resulting 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 has serious consequences for he alth in very rare cases.
Feedback on the use of epidural pain relief
Each organism is individual, therefore, if some tolerate general anesthesia well, then epidural anesthesia is preferable for others. He has reviews inmostly good.
Most patients note the good quality of anesthesia, 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 labor say that in the presence of high blood pressure, the use of epidural anesthesia allows you to keep the indicators within the normal range, which only has a positive effect on labor.
But negative feedback is also not complete. Some patients after such anesthesia feel a severe headache, pain in the back. There are also those on whom the drug simply did not work, and the blockade of nerve endings did not occur.
Looking through all the reviews, we can only draw one conclusion: any type of anesthesia requires a competent specialist approach. If even the simplest anesthesia is treated negligently, 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 with the doctor in advance so that later there are no unwanted manifestations.
Of course, it would be absolutely ideal if no one needed surgery, which means that anesthesia would not be needed either. But our life realities are such that sometimes an operation cannot be avoided in order to save life and he alth. Take care of yourself and stay he althy.
