The treatment of some diseases that occur in our bodies is only possible with surgical interventions. Before the surgical intervention, the application of anesthesia, which means the numbing of the area where the operation is planned, or the temporary inhibition of the body’s sensations in general, is of great importance. In this direction, one of the anesthesia methods applied today is epidural anesthesia.
What is Epidural Anesthesia?
Pain and touch sensations in our body trigger nerve transmissions in the relevant limbs first to the spinal cord, where they are then felt through the spinal cord and transmitted to the brain. Nervous tissues in the brain and spinal cord are surrounded by three different types of membrane tissue called the meninges. From the inside out, these membranes are called the pia mater, arachnoid mater, and dura mater, respectively. Between the arachnoid mater and the dura mater is the cerebrospinal fluid, which has various properties and functions. The meninges have various functions, especially the protection and support of nerve tissues.
In certain surgical operations, if the area to be operated on is a limited area and the application of anesthesia only to this area will be sufficient, general anesthesia, which means putting the whole body to sleep, is not preferred. Instead, depending on the type and size of the operation, either limited anesthesia of the operation area is provided (local anesthesia) or one half of the body is temporarily anesthetized. This is done by injecting anesthetic substances into the spaces between the meninges.
If the anesthetic is applied to the space between the dura mater and the arachnoid mater, which also contains the cerebrospinal fluid, it is called subdural or spinal anesthesia. If an anesthetic substance is applied to the limited space between the dura mater and the connective tissues outside it, it is called epidural anesthesia. In this context, in the application of epidural anesthesia, the meninges are not damaged and the cerebrospinal fluid does not need to be drained. Technically, epidural anesthesia is easier than subdural anesthesia and causes fewer side effects. In addition to these, there are many other advantages as well.
Although epidural anesthesia is often on the agenda for normal birth or cesarean section operations, it is a method that can be safely applied for a wide variety of surgical procedures involving the lower half of the body. In this sense, epidural anesthesia is in the field of interest of all kinds of surgical branches.
How Is Epidural Anesthesia Performed?
Epidural anesthesia is applied from the lumbar vertebrae in the lumbar region of the spine. Due to the fact that the spinal cord tissue in this region shows the nerve extensions, possible damage during the application is prevented. During the procedure, the patient takes a sitting position and leans forward so that his spine is clear.
The correct level is determined by the specialist physician by examining it with his hand and cleaning the area to be intervened with an antiseptic solution.By interfering with a syringe needle at the right level, it advances the needle with slow and smooth movements until it reaches the epidural space. After reaching the epidural space, a plastic catheter is inserted through the needle and the catheter is fixed. The needle is removed and the anesthetic is injected through the fixed catheter.
The catheter can be left fixed during surgery, depending on the possibility of needing additional anesthesia applications. It may take 10–20 minutes for the anesthetic effects to appear after the application. Thanks to the anesthesia, the pain and touch sensations in the lower half of the body are completely lost, while the patient does not lose consciousness and remains awake. In the meantime, the preparations for the surgical intervention to be performed are continuing.
During this whole process, the patient is constantly being followed up on and the anesthesiologist is present in order to control any side effects that may occur in the patient. The anesthesia status of the patient is constantly checked and the surgical procedure is started only after the numbness is fully achieved. After the procedure, the catheter used for anesthesia is removed and the patient is followed up.
Why is Epidural Anesthesia Preferred?
Each anesthetic application has its own advantages and disadvantages, as well as the risk of causing certain side effects. Additional diseases and special conditions of the patient are also factors that affect the final decision in the selection of anesthesia method. In this regard, there are conditions in which epidural anesthesia is preferred over other methods.
The most basic distinction here is the difference between general anesthesia and regional anesthesia. General anesthesia carries the risk of more serious side effects and is more difficult to administer. It requires strict follow-up during and after the application. In addition, regional anesthesia is a method that is less likely to cause side effects because it is applied in a short time. Easily applicable; the patient may be able to move in a short time after the procedure.
Epidural anesthesia has several advantages in terms of the following features:
- The sense of pain is completely blocked. In this way, the person has an easy operation without any pain in the surgical procedure or birth.
- Thanks to the absence of pain, the person can rest more efficiently and comfortably after the surgical procedure.
- During surgery, a person who has received epidural anesthesia can remain awake without feeling pain or suffering.In this way, in special surgeries such as childbirth, one can be aware of the operating environment and the baby and mother can be brought together after birth.
- A small amount of cerebrospinal fluid must be drained before the anesthetic agent is administered in the spinal anesthesia method.It both causes interference to the meninges and causes side effects such as headaches due to the discharged fluid. In epidural anesthesia, these risks are eliminated since no operation is performed on the meninges.
Since the lower part of the body is completely anesthetized with epidural anesthesia, all kinds of minor surgical procedures related to this area can be performed. In this context, epidural anesthesia may be preferred for the following surgical procedures:
- Normal birth
- Cesarean section
Various gynecological surgeries, such as removal of the uterus,
Various interventions, such as stone removal, prostate surgeries,
- Inguinal hernia operations
- Minor orthopedic procedures
Some regional vascular surgeries
Is it Possible to Give Birth with Epidural Anesthesia?
The interventions in which epidural anesthesia is used most frequently are normal birth and cesarean section operations. Some expectant mothers may prefer epidural anesthesia to have a painless normal delivery, to stay awake during a cesarean section, or to avoid general anesthesia. While it eliminates the pain and pain felt during childbirth, it does not prevent the occurrence of uterine contractions. In this way, the expectant mother can give birth more easily.
Even if the mother does not feel the processes such as episiotomy incision or labor pains during birth, she continues to push again during normal delivery. However, in some cases, it has been observed that epidural anesthesia complicates the pushing process.
In addition, after the birth, with the help of epidural anesthesia, the mother and baby can be brought together in the operating room immediately. It is very beneficial for the mother to see her healthy baby, for maternal health and for the prevention of various disorders such as postpartum depression. In addition, the mother can get rid of the anesthetic effects in a shorter time after epidural anesthesia and have an easy and effective rest period. Since it gives birth without pain, it is protected from problems related to birth concerns.
What Are the Risks of Epidural Anesthesia?
As with any anesthetic intervention, there are various risks that epidural anesthesia presents. In this regard, a comprehensive evaluation is conducted by the physician before the anesthesia application, and the patient’s suitability for anesthesia is examined. It is not appropriate to administer epidural anesthesia to patients with the following characteristics:
- People with bleeding disorders or taking blood thinners
- Those who have an infection in the area where epidural anesthesia will be applied
- Those who are allergic to drugs used in anesthesia
- Those who have undergone lower back surgery
In patients who do not have these features and suitable surgical procedures are planned, epidural anesthesia can be performed with the approval and supervision of the physician.
What are the side effects of epidural anesthesia?
Depending on the anesthetic agents used in epidural anesthesia, various side effects may occur during or after surgery. While some of these side effects may be serious and require intervention, some are followed up and lose their effect over time. The effects seen with epidural anesthesia can be listed as follows:
Low or high blood pressure
- Back pain
- Severe headache
Bleeding, bruising, or swelling in the area where anesthesia was applied.
Very rarely, nerve damage
The likelihood of these symptoms occurring is very low. Epidural anesthesia can be applied easily and safely without any side effects. In the event of side effects that occur during the operation, they can be controlled by the anesthesiologist. After surgery, numbness in the lower half of the body may persist for a while, or milder side effects may occur. In this case, the temporary discomforts are eliminated with additional treatment methods.