Some say that anesthesia is the most dangerous part of surgery-and there's some truth to that, if you're talking about general anesthesia. Taking a person (sometimes a very sick one) just past the brink of consciousness and keeping him/her safely there without compromising vital organ function requires skillful use of some of the most lethal drugs in the world. It is indeed risky business, which is a key reason why doctors are doing more procedures today with epidural anesthesia, a form of regional pain block that halts the pain transmission to the spinal cord.

Epidurals are not only used for many types of surgery, both major and minor, they are used to treat chronic pain-but don't make the mistake of thinking they are "no big deal." Like all medical procedures, epidurals carry risks.

What You Need To Know

According to Asokumar Buvanendran, MD, director of orthopedic anesthesia at Rush University Medical Center in Chicago, epidurals are generally safe when performed by a trained and experienced anesthesiologist. But, he said, it is important to remember that these are still delicate procedures involving the spine, home to a large portion of the neurological system.

The word "epidural" refers to the spot where the medication is injected—the epidural space adjacent to your spinal cord. The area is numbed with an injection, then a catheter through which the medication is injected is put into place. The medication blocks pain messages from being felt and processed by the brain. The epidural catheter may be left in place for a few days following an operation to manage the postsurgical pain in the hospital. An even newer development is that a catheter and pump may be left in place to deliver an analgesic for several days or weeks after the patient returns home. Also relatively new is that epidurals are being used to manage chronic pain--for instance, epidural steroid injections (ESIS) are a treatment for low back or neck pain.

Is It All Good?

Epidural anesthesia is widely used during labor and childbirth, as well as for many procedures, Dr. Buvanendran said, including gynecological surgery, orthopedic procedures, and cardiac and lung operations. For some surgeries, an epidural is sufficient on its own, though for others (such as heart or lung surgery) it accompanies general anesthesia.

Local anesthetics often provide enough pain control with epidural application, minimizing the need for opioid drugs. Delivering the anesthetic directly to the affected nerves reduces the likelihood that patients will suffer systemic side effects as they would with morphine and other narcotic drugs that enter your bloodstream.

These reasons typically add up to fewer adverse effects, fewer complications and better surgical results with epidurals than with general anesthesia, Dr. Buvanendran said. But that's not to say that an epidural has no potential downside. Possible complications include…

  • Low blood pressure. Epidurals sometimes lead to a decrease in blood pressure.
  • Soreness. Soreness, swelling and irritation at the insertion site may occur.
  • Allergic reactions. Epidural administration doesn't sidestep potential drug allergies. Most reactions are minor-eg, a mild skin rash-but severe asthma-like reactions can occur (this is a medical emergency).
  • Urinary difficulties. An epidural may temporarily block your ability to empty your bladder.
  • Infection and bleeding. Uncommon but possible, these are sometimes problems for patients with compromised immune systems or they may be the result of misplacing a catheter or less than optimal hygiene.
  • Severe headache. It's rare, but epidural patients sometimes develop a postdural puncture headache (PDPH) that may arise as late as seven days after the procedure and can then last for several days. This occurs when a needle puncture goes too deep, causing a leakage of spinal fluid. Though it is horribly painful, it's not dangerous.
  • Temporary neurological injury, paralysis, respiratory arrest, death. These worst-case scenarios are rare but have been known to occur.

What You Can Do

If you and your doctor agree that an epidural might be a good choice for you, make sure to find a board-certified anesthesiologist who is trained and very experienced in epidural use. This is the best way to avoid potential side effects and to obtain the safest possible epidural. Administering an epidural is an art, observes Dr. Buvanendran. The more frequently a doctor performs it, the better his/her technique.

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