What is epidural anesthesia?
An anesthesiologist or certified registered nurse anesthetist (CRNA) will perform the epidural procedure. These health care providers specialize in giving medicines to relieve pain. Some epidurals are given as 1 injection (shot) to provide short-term pain relief. Most epidurals use a small tube called a catheter so that medicines can be given over a longer time.
Your provider decides how much pain medicine your child needs based on your child’s age, body size, type of procedure, and medical needs.
Benefits of epidural anesthesia
The goal of an epidural is to reduce or prevent pain. This can help your child breathe more deeply, sit up or move more easily, and sleep better so that they recover faster.
Epidural medicines can control pain without some of the side effects of other types of medicines. An epidural may reduce the amount of opioids needed, lowering the risk of possible constipation.
With epidural anesthesia your child may be more alert and less groggy. Pain medicines given as a pill or through an intravenous (IV) line can make your child feel sleepy. That is because some of the drug goes to the brain. Less drug goes to the brain with epidural anesthesia.
What to expect with epidural anesthesia
Your child will lie on their stomach or side on the procedure table. The anesthesia provider will clean and numb the area of the back where the epidural will be given.
Once the area is numb, a thin needle is used to place a small tube called an epidural catheter. The needle is removed, leaving the catheter in place. It is about the size of a fishing line.
The other end of the catheter connects to a pump. The pump gives pain medicine. The medicine blocks pain messages sent by the nerves to the brain. The amount of pain medicine your child gets can be changed as needed.
The catheter will be secured with tape. After the procedure, most children cannot feel the epidural catheter or the medicines.
Possible side effects of epidural anesthesia
Epidurals are generally safe, but any medicine used to manage pain can cause side effects.
The most common side effects of an epidural are:
- Numbness, tingling, and weakness in the legs, feet, or buttocks
- Itching
- Problems urinating (peeing)
- Nausea or vomiting
- Feeling sleepy or drowsy
- Slow breathing
- Skin redness or irritation from the tape that holds the epidural catheter in place
- Mild pain or tenderness at the epidural site. This goes away after a few days.
Rare, more serious side effects can happen. These include:
- Infection
- Pain
- Drop in blood pressure
- Headache
- Nerve problems
- Bleeding. If bleeding happens, it may push on nerves and spinal cord, causing an injury.
There is a small risk that the needle used to place the epidural catheter can enter the spinal space instead of the epidural space. If this occurs, your child may have a headache for a few days. There is a very low risk of infection or bleeding around the catheter. But in some rare cases it can cause nerve damage.
Your care team will watch your child for early signs of these problems. Let your care team know about any side effects or pain.
After epidural anesthesia
Your care team will assess:
- Your child’s pain level
- Breathing and oxygen level
- How the tape on the dressing sticks to the skin
- The connections of all parts of the pump (infusion) system
Breakthrough pain can sometimes occur with an epidural. If your child is old enough, the care team will ask them to use a pain scale to describe the level of pain.
At times, the care team will ask your child to move their legs. This is important to make sure the medicines and catheter do not cause any serious side effects. One goal of giving pain medicine using an epidural is to allow children to move their legs. Your child may get out of bed with help if the care team says it is OK. Call a nurse or physical therapist the first time your child gets out of bed.
The epidural catheter will have a clear dressing over it. You will not need to change the dressing. Let your care team know if the dressing becomes loose.
Your child will have a foley catheter while the epidural is in place. Most often, the epidural catheter will remain in place for 2–5 days. At that point, your child can take other pain medicines by mouth or IV.
Removing the catheter is fairly painless. The pain provider will use adhesive remover to make the tape come off easier. After the catheter is removed, the self-stick bandage will be placed on the site. The bandage needs to stay in place for 1 day.
When to call your care team
If you have questions or concerns about the epidural, please talk to your care team. Let your care team know if:
- Your child seems to be in pain
- The epidural catheter comes out or disconnects from the pump tubing
- The dressing (covering) is loose
- You see fluid collecting under the dressing
- Your child is very sleepy or hard to wake up
- Your child starts breathing faster or slower than normal
- Your child complains of itching
- Your child feels sick to their stomach
- Your child wants to turn or get up
- You have questions or concerns
Questions to ask your care team
