What Is the Use of Epidural Anesthesia for Caesarean Sections?
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Epidural Anesthesia for Cesarean Sections

Published on Nov 16, 2022 and last reviewed on Nov 18, 2022   -  4 min read


A cesarean surgery requires special anesthesia called epidurals that performs to deliver the baby if the baby is unable to pass through the vaginal path.


Cesarean surgery is for childbirth when the baby delivers through an incision given in the lower abdomen and womb. This surgery requires specialized anesthesia to perform and reduce the pain. The anesthesia used mainly is epidural anesthesia. Pain during childbirth or labor is very intolerable and affects the mother and the baby. All women experience different levels of pain. However, it is not similar for everyone. Therefore, anesthesia is required to control the pain in women. The doctor uses regional anesthesia commonly. Epidurals are regional anesthesia.

What Are Cesarean Sections?

Cesarean is required when the baby fails to be born through a vaginal path because of the position of the baby or placenta position or when the mother or baby is at risk. So, the cesarean is the plan to extract the baby from the womb by giving cuts to the lower abdomen and womb. There are few possibilities for having confirmed cesarean surgery. They are:

  • Labor pain fails to occur naturally.

  • Previous history of cesarean cases.

  • The baby presents in an odd position, making him unable to use the vaginal path.

  • The placenta is attached to the lower uterus.

  • Mother with twin case.

How Is Cesarean Surgery Performed?

The doctor starts the cesarean surgery after the anesthesia starts working. The patient has numbness in the leg and lower abdomen area. The doctor gives a horizontal incision (cut) about 4 to 6 inches in the abdomen near the pubic hairline. The incision goes from deep skin to fascia to the uterus walls, and the baby delivers through the cut. It takes an hour to complete the surgery. The baby takes 10 to 15 minutes, even less in an emergency. After baby delivery, the stitchings of the uterus wall and fascia are done. Again, the stitchings take time, more than the baby’s delivery.

What Is the Anesthesia Given in Cesareans?

Anesthesia used in cesarean can be epidurals, spinal or general anesthesia. Depending upon the case, the anesthesia is decided. It includes:

  • Epidurals - Epidurals are the most commonly used regional anesthesia in cesareans. Before going for surgery, epidurals are given on the back of the patient, in the epidural spaces just outside the spinal sac by injection or by some specialized catheter, relieving the patient from pain.

  • Spinal Blocks - Spinal blocks are used along with epidurals in cesareans. Spinal blocks are given at the back of the spinal sac by injection or by a tiny catheter. It numbs from the abdomen to the legs and relieves the pain. It lasts for about three hours.

  • General Anesthesia - It relieves the pain but loses the patient's consciousness. General anesthesia exposes the baby to some medication. It is ideally not the doctor's first choice, but in cases like a mother bleeding or being unstable to cooperate during surgery, make a doctor use general anesthesia.

How Is Epidural Anesthesia Administered?

Epidural anesthesia is administered to the patient by laying the patient on one side or making the patient sit. The skin is cleaned with an antiseptic solution. Local anesthesia is applied to lower the pain of the needle used. A specialized catheter with a needle containing an exact appropriate dose of medicine is inserted in the epidural space just outside the spinal sac.

After maintaining a proper position, the catheter remains even after removing the needle. The catheter remained to provide medicine for pain relief post-surgery. The epidural takes 10 to 15 minutes to work. It lasts for about three hours.

There are a few guidelines for the administration of epidural anesthesia. They are:

  • An anesthesiologist should conduct an evaluation and should have informed consent.

  • Emergency equipment should be present to handle the complication during the surgery.

  • Always disinfect the skin with two percent Chlorhexidine.

  • Monitoring fetal blood pressure and maternal blood pressure is essential.

  • The infusion rate of anesthesia needs to adjust to minimize the effects and complications.

  • Monitor the respiratory rate.

  • After the delivery, remove the catheter.

What Are the Drugs Used in Epidural Anesthesia?

The drugs used in the epidurals are the same as in local anesthesia. Some factors to consider in selecting the most appropriate amount of anesthesia are surgery duration, surgery requirement, and duration of anesthesia. Chloroprocaine, Lidocaine, Mepivacaine, Bupivacaine, and Ropivacaine are used in epidural anesthesia. Epidural anesthesia should have preservation-free solutions. Epinephrine is also used in epidural drugs to increase the effectiveness of the block by reducing toxicity and bleeding.

Anesthesia during surgery does have some complications. It includes:

  • The most common complication doctor faces the post-dural puncture headache occurring due to the puncture of the dura with a needle. And the headache is usually caused by leakage in a cerebrospinal fluid resulting in lowering intracranial pressure. The doctor often resolves the headache with an epidural blood patch.

  • Postpartum urinary retention can also occur but can be controlled by avoiding sensory blocks.

  • Hypertonic uterine contractions are also seen but managed by Nitroglycerin or Terbutaline.

  • Maternal hypotension is present in 80 percent of the patients. If a decrease in blood pressure occurs, it can cause less blood flow to the fetus. So, before epidurals, the doctor gives an isotonic electrolyte solution to the patient.

  • Some rare but serious complications are epidural hematoma (when blood gets collected in the epidural area), epidural abscess (when fluid gets collected in the epidural space and can cause swelling and pain), or neurologic injury.

  • Even a high dosage of anesthesia can cause respiratory and cardiac arrest.

What Are the Contraindications for Epidural Anesthesia?

Contraindications to epidural anesthesia during labor include:

  • Patient refusal.

  • Maternal hemorrhage.

  • Infections.

  • Signs of coagulopathy.

  • Septicemia (blood poisoning by bacteria and its toxins).


Epidural anesthesia is a very effective way to go through cesarean surgery by reducing the intolerable pain of the patient (mother). The doctor can combine the epidurals and spinal blocks. For combined epidural-spinal cesarean sections, spinal anesthesia is initially delivered, followed by epidural anesthesia with a catheter. The catheter is removed at the end of the surgery. It takes nearly 15 minutes to work and lasts for about three hours. Then, the cesarean surgery starts with a horizontal cut on the lower abdomen. Unfortunately, epidural anesthesia shows complications of maternal hypotension and post-dural headaches. Some cases even have urinary retention as a complication of epidural anesthesia. Complete management to overcome the difficulty makes a success in surgery.

Frequently Asked Questions


Why Is Epidural Anesthesia Preferred in C-Sections?

Epidural or spinal anesthesia is preferred in C-sections because the baby is subjected to the lowest amount of medication and the mother can actively take part in the baby’s birth. A long-acting painkiller may be given with an epidural to relieve pain in the first 18 to 24 hours after the C-section. General anesthesia is not recommended as it can cause complications in the mother. An epidural or spinal block is generally regarded as safe for the mother and her baby.


Is Epidural Anesthesia in C-Sections Painful?

There is usually no pain, but a sense of pressure may be felt when the needle is being inserted. The mother will be aware of the procedure being done but cannot experience any pain. Few mothers experience a sensation of tugging or pulling when the baby is removed from the abdomen. The physician will numb the epidural site, which will cause a mild stinging or burning sensation. This numbness will create very mild pain when an epidural injection is given.


Which Is Best- Epidural or Spinal Anesthesia in C-Section?

Spinal anesthesia is advantageous in that patients are more comfortable, it is quick to perform, complications are less frequent, and it is cost-effective. It is preferred by doctors in C-sections or complicated cases since it gives immediate relief and low doses can be injected. The medical team prefers an epidural for first-time mothers since labor pain can last for 12-18 hours and an epidural can offer a long period of relief, while spinal anesthesia can offer relief for only 1-2 hours. 


What Kind of Anesthesia Is Recommended for a C-Section?

Spinal or epidural anesthesia is usually recommended for C-sections. These are opted for since the baby is subjected to low doses of medication and the mother can actively participate in the delivery process. General anesthesia is not given unless necessary, as it is associated with maternal complications, infection at the surgical site, etc. The majority of C-sections are done under spinal or epidural anesthesia, which causes numbness only in the lower body.


Does Epidural Anesthesia Increase the Chance of a C-Section?

Few studies show that women who had epidural anesthesia were 2.5 times more likely to have a C-section, but other factors need to be considered. Whether or not epidural anesthesia increases the chance of a C-section is debatable, and the risks and benefits of epidural anesthesia should be discussed with the patients and informed consent obtained.


How Long Does Epidural Anesthesia Last in a C-Section?

After epidural anesthesia is given, the needle is removed, and the mother is relieved of pain immediately. This can last for 1.5-3 hours. Numbness will extend from the abdomen to the legs, and there is no pain involved. C-section surgery can last for 30-60 minutes. Bladder sensations cannot be appreciated after epidural anesthesia. Epidural anesthesia eases pain and causes less stress during birth.


What Are the Risks Associated With Epidural Anesthesia?

Epidural anesthesia is generally safe but can have minimal risks like temporary loss of bladder control, feeling sick, itchy skin, headaches, and nerve damage. It can lower the blood pressure in the mother, which in turn can slow down the baby's heartbeat. Sometimes, it can also create difficulty pushing the baby, and the dosage needs to be adjusted under such conditions. Long-term complications are usually rare with epidural anesthesia.


Which Can Be Preferred- Epidural or General Anesthesia?

Epidural anesthesia reduces the occurrence of respiratory complications and blood loss when compared with general anesthesia. Epidural or spinal anesthesia is preferred in C-sections because the baby is subjected to the lowest amount of medication, and the mother can take part in the baby’s birth actively. Unnecessary general anesthesia is linked with maternal complications and infections at the surgical site and poses other risks.


Will I Be Able to Walk After Epidural Anesthesia?

A majority of the women are unable to walk after epidural anesthesia but can move their legs. It might take around half an hour to an hour after epidural anesthesia to be able to walk, but the walk will be abnormal. Epidural anesthesia is given in low doses during the first stage of labor so that the woman can get up and walk to ease the delivery. It might take a few hours after delivery to walk normally, and during this time, support should be provided by a caretaker.


Will the Delivery Be Painful After Epidural Anesthesia?

Epidural anesthesia offers great relief from labor pain but is not 100 percent pain-free. A tugging sensation or mild pressure will be felt, but the pain will not be consistent. Strong contractions cannot be appreciated under epidural anesthesia in a few women. This makes it difficult to push the baby, and the dosage needs to be adjusted. In case of the abnormal position of the baby in the pelvis (hip), an epidural can also pose difficulty for the baby to move from this position.


Is Epidural Advisable for Natural Childbirth?

Epidural anesthesia causes numbness in the lower part of the body. Women who deliver without any pain relief medication go through short labor and pushing phase. This helps the women to utilize their natural labor hormones and remain active during labor. Sometimes, strong contractions cannot be appreciated under epidural anesthesia, making pushing difficult. An epidural can prolong the pushing phase, but few women prefer it over intense pain.


Can Epidural Anesthesia Cause Permanent Complications?

Serious, long-term complications due to epidural anesthesia are rare. A few women may experience discomfort in the lower back for a few hours or days after the catheter is inserted, but it gets resolved. Rare, long-term complications include permanent spinal cord or nerve damage, breathing issues, and persistent numbness or tingling. The injection site and labor process can cause back pain, which is uncommon due to epidural anesthesia.


Is an Epidural Needle Big?

The physician will numb the epidural site before epidural anesthesia, which will cause a mild stinging or burning sensation. The epidural needle will be about three and a half inches long and slightly wider than those used for flu shots. The spinal needle is a 27-gauge needle. Since the epidural site was previously made numb, very little pain will be felt, and one can experience a pressure sensation during epidural anesthesia.


How Long Does It Take for an Epidural to Wear Off?

After epidural anesthesia, the lower part of the body becomes numb. It takes 1-2 hours for the effects of epidural anesthesia to wear off. The legs may feel weak and require walking support until a complete sensation is gained. The epidural is given until delivery and will be withdrawn after that. Painkillers may be given to relieve pain after delivery. 


Is Delivery Painless With an Epidural?

The biggest advantage of having epidural anesthesia is that it significantly reduces labor pain and enables the mother to participate actively in the birthing process. This also helps the mother to relax and save energy for the pushing phase. Few mothers experience a sensation of tugging or pulling when the baby is removed from the abdomen in a C-section. Pain is minimal; just pressure sensations can be felt with epidural anesthesia.

Last reviewed at:
18 Nov 2022  -  4 min read




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