Epidural Anaesthesia

Epidural anaesthesia is associated with the following benefits:

• Avoidance of risks associated with general anaesthesia: Low risk of nausea, vomiting, sore throat, and memory problems.
• Highly safe: Low risk of complications such as aspiration, breathing difficulties, or adverse reactions to general anaesthetics.
• Excellent pain relief
• Speeds up recovery
• Haemodynamic stability: Suppresses the surgical stress response, improving blood pressure control during surgery.
• Chronic pain treatment: Epidural anaesthesia is an effective treatment option for chronic pain management, especially for conditions related to the spine, such as herniated discs, sciatica, and spinal stenosis

Epidural anaesthesia is administered via the following steps (after the preoperative stage):

• Identification of the epidural space: The epidural space, i.e., the site of injection is identified to ensure safe needle placement.
• Needle insertion and catheter placement: A thin, flexible tube is inserted through the needle to access the epidural space and deliver local anaesthetics and/or pain relief medications.
• Test dose administration: Before administering the final dose, a small amount of anaesthetic mixed with adrenaline (epinephrine) is administered to check for tachycardia (rapid heartbeat) or metallic taste (indicating accidental vein injection) and rapid numbness or motor block (indicating accidental dural puncture). If both are negative, the anaesthetic is administered.
• Drug administration: A local anaesthetic (e.g., bupivacaine) is injected into the epidural space, either as a single dose (bolus) or continuously, through the catheter to block nerve signals and provide pain relief. This technique results in slow numbing of the target region (10 to 25 minutes for numbing).
• Monitoring: Vital signs like blood pressure, heart rate, and oxygen saturation are continuously monitored, and signs of low blood pressure looked out for.
• Onset of anaesthesia: Numbing is checked using a pinprick test or cold swab.
• Post-procedure steps: After the completion of the procedure, the catheter is removed and patients are observed for complications like low blood pressure (hypotension), infection, or bleeding (and in rare cases, dural puncture‒associated headache).

Generally, epidural anaesthesia is safe, but in some cases, depending on the patient’s overall health, some risks may exist:

• Common risks:
• Temporary hypotension (low blood pressure): Symptoms such as dizziness, nausea, or fainting may occur.
• Spinal headache and/or back pain: Neck stiffness, nausea, and light sensitivity may also occur.
• Urinary retention: This may occur due to the disruption of the function of the sacral nerves, which control bladder function.
• Rare but serious risks:
• High or total spinal block: Sometimes, breathing muscles or brainstem function may be affected, causing hypotension, slow heartbeat, or unconsciousness.
• Neurological complications: Persistent numbness, weakness, tingling, or, in extremely rare cases, paralysis, may occur due to direct nerve injury, spinal cord trauma, or the leakage of blood into the surrounding tissues due to incorrect anaesthesia administration.
• Infections: Infections such as meningitis may occur when the correct disinfection protocols are not followed during the administration of anaesthesia.
• Allergic reactions: If the patient is allergic to the anaesthetic or preservatives used, symptoms such as rash, itching, or anaphylaxis (a severe, potentially life-threatening allergic reaction) may occur.

In case epidural anaesthesia does not provide the desired level of pain relief or if the patient is incompatible with the anaesthetic(s) used, general anaesthesia is often considered.