Epidural blocks

An epidural block is an anesthetic and narcotic mixture. Anesthetics used include chloroprocaine, lidocaine and other "caine" drugs. Narcotics used include fentanyl (Sublimaze), meperidine (Demerol), morphine and nalbuphine (Nubain).

When it's administered

The epidural block is used during active labor. It can also be used for Caesarean births.

How it's administered

The medication is injected into a space surrounding the spinal nerves. It takes about 20 minutes to administer, and it can take another 20 minutes for the pain relief to begin working. It can be administered continuously or off and on throughout labor.

How it affects you

Depending on the balance of anesthetic and narcotic, the epidural temporarily blocks pain in the lower body or alters your perception of the pain. In either case, it's a highly effective pain relief method that may be used continuously for several hours. A form called walking epidural provides pain relief but leaves you with enough muscle strength to walk during labor. Epidural techniques allow you to remain awake and alert. After dilation to 10 cm, the balance of medications may be altered to ensure perception of pushing.

Possible concerns

Occasionally, due to variations in a person's anatomy, the block may work better on one side than the other. The most common side effect that causes concern is a decrease in your blood pressure. Very rarely, this is enough of a drop to make you feel faint or nauseated. More often, the drop is enough to decrease blood flow to the placenta, which may cause your baby to experience some temporary drops in heart rate. Scientific studies don't support that it causes a significant slowing of labor.

If too much medication is used, the block may affect the muscles of your chest, making it hard to perceive breathing. It's a scary side effect, but very manageable. It's also rare. Allergies to medications also may occur.

In rare cases, the needle perforates the membrane that holds the spinal fluid around the spinal canal. Occasionally, such a perforation leaks for a short time, which can give you a severe headache (spinal headache) when you're sitting up or standing.

Receiving an epidural block

To receive an epidural block:

1. You lie on your side in a curled-up position or sit on the bed with your back rounded.

2. The doctor numbs an area of your back with a local anesthetic.

3 The doctor inserts a needle into the epidural space just outside the membrane that encloses the spinal fluid and spinal nerves. 4. A thin, flexible tube (catheter) is threaded through the needle, and the needle is removed. The catheter is taped in place. 5 The medication is injected through the catheter. The medication flows through the catheter to surround the nerves, blocking the pain.

Dura-

Epidural space-

Epidural-

catheter

Needle-

Spinal nerves

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