Epidural Injections and Back Pain - An Overveiw

Introduction

Epidural anesthesia is a common procedure to relieve pain or loss of sensation during labor and delivery, some surgical procedures, and some causes of chronic pain. Epidural anesthesia is generally a very safe procedure, but it does have some risks and possible side effects.

What Is Epidural Anesthesia?

An epidural is a procedure that involves injecting a drug - an anesthetic or steroid - into the space around the spinal nerves called the epidural space. The goal of an epidural is to relieve pain (analgesia) or completely eliminate sensation (anesthesia) in an area of ​​the body, such as the leg or stomach. Epidural anesthesia is often referred to by the following terms:

• Epidural block.

• Epidural anesthesia.

• Epidural steroid injection (ESI).

• Regional anesthesia.

• Neuraxial anesthesia.

How Does Epidural Anesthesia Work?

Epidural injections work by injecting numbing medicine into the epidural space around the spine so that it can block pain signals traveling from the spine to the brain. Think of epidural space as a fluid sleeve surrounding the spinal cord.

The spinal cord acts like a highway connecting nerves throughout the body to the brain.

During injury, the nerve in that area of the body sends a pain signal that travels through the spinal cord to the brain and reverse. An epidural anesthetic numbs the spinal nerves temporarily blocking pain signals in a specific region of the body depending on where along the spine the physician injected the epidural.

Epidural anesthesia provides short-term pain relief or a complete lack of feeling. The following factors are responsible for how much feeling the patient temporarily loses from an epidural:

• The type of anesthetic drug the physician uses.

• The concentration of the drug (how strong it is).

• Dosage of the drug.

Epidural steroid injections (ESI) work a little differently and are used to control chronic pain. Instead of anesthetics, the doctor will inject steroids or corticosteroids into the epidural space around the spine. Instead of blocking pain or sensation in an area of ​​the body, steroids coat the irritated nerve(s) causing the pain and help to reduce swelling.

Steroids help the nerves to heal leading to interim, or permanent pain relief.

What Are Epidurals Used For?

The healthcare physician may suggest an epidural in the following conditions:

• Pain relief during labor and childbirth.

• As an alternative to general anesthesia for certain surgeries.

• Pain relief after certain surgeries.

• To control some causes of back pain and other forms of chronic pain (using epidural steroid injections).

Epidural Anesthesia During Labor And Birth-

There are two general types of epidural anesthesia that are chosen during labor and delivery. Including:

• Epidural Anesthesia Using a Catheter: The physician will give the medication through a catheter in the lower back that is inserted with an epidural injection. The catheter remains in the epidural space so the doctor can give more medication if needed.

• Combined Spinal-Epidural (CSE): CSE is a combination of two injections: Spinal injection (spinal block) and epidural anesthesia. CSE reduces pain much faster than a simple epidural. Since this method requires a lower dose of medication, the patient will feel a little lighter in the lower half. This allows the patient to move more comfortably and change positions. Epidural anesthesia is a common procedure. More than 50 percent of people giving birth in a hospital choose epidural anesthesia. Epidural steroid injection (ESI) is one of the most commonly performed pain relief procedures.

What Are the Risks and Benefits of Epidural Anesthesia?

Benefits of Epidural Anesthesia

Epidural anesthesia has different benefits depending on why the patient received it.

Benefits of epidural anesthesia during labor and delivery include:

• Overall, it is very effective in reducing pain during labor and birth.

• Generally, it is very safe.

• The patient can still move around in bed regularly and push when needed.

• If the labor is long, an epidural will help in sleeping and regain strength.

• During a cesarean section (C-section), the mother can be awake during the birth, and the partner can also be present.

• An epidural can be given at any time during labor.

Benefits of epidural anesthetic injections during surgery include:

• Experience less nausea and vomiting than with general anesthesia.

• After surgery, recovery is faster than with general anesthesia.

• Decreased risk of a blood clot formation in one of the veins in the leg.

Benefits of Epidural Steroid Injections Include:

• The patient might experience temporary or long-term pain relief.

• They likely experience a better quality of life and a better ability to perform daily activities without the limitations caused by previous pain.

• Epidural steroid injections can help determine the cause of the pain. This is often a problem in people who have more than one cause of pain.

• It may decrease the requirement for more invasive procedures for pain relief.

What Are the Risks or Complications Associated With Epidural Anesthesia?

Epidurals are generally safe, but they carry the risk of some side effects and complications. Although rare, risks and complications that occur with all types of epidural procedures include:

• Having low blood pressure can make the patient feel dizzy.

• Severe headache due to a cerebrospinal fluid leak. Less than 1 percent of people experience this side effect.

• Infection after an epidural procedure, such as an epidural abscess, osteomyelitis, or meningitis (inflammation of meninges).

• Negative reactions to the medication, such as hot flashes or rash.

• Bleeding occurs due to accidental damage to blood vessels during injection. This can form a hematoma or blood clot.

• Nerve damage at the injection site.

• Temporary loss of bladder and bowel control.

Disadvantages and risks that apply to epidural anesthesia during labor and delivery specifically include:

• The patient may lose feeling in the legs for several hours.

• This may delay the second stage of labor.

• They may not be able to push and need help to give birth.

Risks and complications that apply to specific epidural steroid injections include:

• Feeling a temporary increase in pain.

• If the physician uses fluoroscopy or CT (computed tomography) scanning to guide imaging, exposure to low-level radiation from X-rays will be minimal.

• In the case of diabetes, steroid injections may cause high blood sugar (hyperglycemia). This can last several hours or even days.

Can Epidural Anesthesia Cause Back Problems?

It is commonly believed that an epidural causes back pain, but it is very rare for an epidural to cause chronic or long-term back problems.

It is normal for the patient to have temporary back pain or soreness at the epidural site. This usually goes away within a few days.

This belief may stem from the fact that many people giving birth experience back pain after labor and delivery, whether they had an epidural or not. This is because the bones and ligaments in the pelvis will return to their original pre-pregnancy position, which can cause back pain and discomfort.

Does Epidural Anesthesia Cause Long-Term Side Effects?

Although very rare, epidural anesthesia can cause some long-term complications, including:

• Permanent nerve damage due to damage to the spinal cord or nerve roots caused by epidural injections.

• Chronic pain due to damage to the spinal cord or nerve roots due to epidural injections.

• Permanent paralysis due to hematoma.

Conclusion

Epidural anesthesia is a common, effective, and generally safe procedure for quickly relieving pain or temporary loss of sensation. Do not hesitate to talk to the doctor about epidural anesthesia and the procedure. They can answer all the questions.