Epidural Anesthesia

What is an epidural?

Epidural anesthesia is commonly called an “epidural.” It is anesthesia that is injected into the epidural space in the spine. The epidural space is between the wall of the spinal canal and the covering of the spinal cord.

An anesthesiologist uses a thin needle to place a small tube called an epidural catheter. An anesthesiologist is a doctor who manages pain.

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.

Why is epidural anesthesia used?

Epidural medicines can control pain without making your child too sleepy. 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. When medicines are directed to pain nerves, less drug goes to the brain.

The goal of an epidural is to reduce or prevent pain so your child can breathe deeply, get out of bed, and sleep in comfort. When patients are more alert, they can know right away if they need more pain medicine. This allows ease in turning, coughing, sitting up, or walking after surgery. These movements help your child recover from surgery.

Does it hurt to get an epidural?

No, most children cannot feel the catheter or the medicines.

What medicines will my child receive through the epidural catheter?

Providers give 2 types of medicines in the epidural catheter. Your child will likely have both types:

• Local anesthetics (numbing agents)
• Opioids (narcotics)

Is it safe to use an epidural to control pain?

Yes. The anesthesiologist decides how much pain medicine your child needs based on your child’s age, body size, type of surgery, and overall medical condition. The doctor can adjust the amount of pain medicine your child receives as needed.

What are the side effects of epidurals?

Any medicine used to manage pain can cause side effects.

The most common side effects are:

• Numbness, tingling, and weakness in the legs, feet, or buttocks
• Itching
• Problems urinating
• Nausea and vomiting
• Feeling very drowsy
• Slow breathing
• Skin irritated by the tape that holds the epidural in place.

Other side effects relate to the catheter rather than the medicines. These rare side effects include infection, bleeding, and headache. The care team will watch your child for early signs of these problems. There are treatments for side effects.

Could my child still have pain?

Yes. This is breakthrough pain. If your child is old enough, the care team will ask them to use a pain scale to describe the level of pain.

Can a child with an epidural move their legs and get out of bed?

One goal of giving pain medicine this way 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. Please call a nurse or physical therapist the first time your child gets out of bed.

When should I call for the nurse?

You should call your child’s nurse if:

• Your child seems to be in pain
• The epidural catheter comes out or has come apart from the pump tubing
• The dressing (medicated covering) is loose
• You see fluid collecting under the dressing
• Your child is too sleepy or hard to wake up
• Your child has a change in breathing pattern
• Your child complains of itching or feels sick to their stomach
• Your child wants to turn or get up
• You have questions or concerns.

How will I know if my child is doing well with the catheter?

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 infusion system

At times, the care team will ask your child to move their legs. This is important to make sure the medicines and catheter are not causing any serious side effects.

What type of dressing will cover the catheter?

The epidural catheter will have a clear dressing over it. You will not need to change the dressing. If the edges become loose or the other tape becomes loose, please tell your child’s nurse.

Are there risks to epidural anesthesia?

Every type of pain relief medicine has risks. These risks include:

• Temporary loss of feeling and no use of certain body parts
• Odd feelings and pain
• Bleeding inside the insertion site that may push on nerves and spinal cord, causing an injury
• A drop in blood pressure
• Infection

If you have questions or concerns about the epidural, please talk to your child’s doctor or anesthesiologist.

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 tube. But in some rare cases it can cause nerve damage.

How long will my child have an epidural?

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.

How will the catheter be removed?

Taking the catheter out of the back is fairly painless. The nurse will use adhesive remover to make the tape come off easier. After the catheter is removed, the nurse will place a self-stick bandage on the site. The bandage needs to stay in place for 1 day.