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Labor Analgesia with Epidural Anesthesia

An epidural delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious. It decreases sensation but doesn’t result in a total lack of feeling. Medication is delivered through a catheter – a very thin, flexible, hollow tube – that’s inserted into the epidural space just outside the membrane that surrounds your spinal cord and spinal fluid. An epidural is the most commonly used method of pain relief for labor in the United States.

To allow the catheter to be inserted, you lie curled on your side or sit on the edge of the bed while an anesthesiologist or nurse anesthetist cleans your back, injects the area with numbing medicine, and carefully guides a needle into your lower back. (This may sound painful, but for most women, it’s not.) The anesthesiologist or nurse anesthetist then passes a catheter through the needle, withdraws the needle, and tapes the catheter in place so medication can be administered through it as needed. You can lie down at this point without disturbing the catheter. First you’re given a small “test dose” of medicine to be sure the epidural was placed correctly, followed by a full dose if there are no problems. Your baby’s heart rate is monitored continuously, and your blood pressure is taken every five minutes or so for a while after epidural catheter placement to ensure that the epidural catheter is functioning properly and not causing any adverse effects.

The medication delivered by the epidural is usually a combination of a local anesthetic and a narcotic. Local anesthetics block sensations of pain, touch, movement, and temperature, and narcotics blunt pain without affecting your ability to move your legs. Used together, they provide good pain relief with less loss of sensation in your legs and at a lower total dose than you’d need with just one or the other.

You will start to notice the numbing effect about 10 to 20 minutes after the first dose of medication, though the nerves in your uterus will begin numbing within a few minutes. You’ll receive continuous doses of medication through the catheter for the rest of your labor in order to ensure adequate pain control.

Not all women are good candidates for this kind of pain relief. You won’t be able to have an epidural if you have abnormally low blood pressure (because of bleeding or other problems), a bleeding disorder, a blood infection, a skin infection on the lower back where the needle would enter, or if you’ve had a previous allergic reaction to local anesthetics. Women taking certain specific blood-thinning medications cannot have an epidural for labor pain management.


What to Expect on Your Day of Surgery


Can I eat or drink prior to undergoing anesthesia?

As a general rule, you should not eat or drink anything after midnight before your surgery. Under some circumstances, you may be given permission to drink clear liquids up to a few hours before your anesthesia. If your procedure is scheduled late in the day you may be permitted a light meal in the early morning. The same rules apply to children. You should always receive written or verbal instructions and call your doctor or the hospital if in doubt. If you smoke, please refrain from smoking for as long as you can prior to the day of surgery. Some surgeries may be cancelled or postponed based on a patient’s smoking status.

What happens if I do not feel well prior to my scheduled surgery?

If you have an upper respiratory infection (common cold), prior to your day of surgery, please contact our Pre-admission Testing (PAT) center at (410) 871-6100. Please inform our PAT nurses of your symptoms so that decisions can be properly made regarding potentially delaying surgery in relation to your symptoms and medical history. Some procedures may be postponed for your safety in order to allow your body to recover from an acute illness prior to surgery.

Should I take my usual medicines?

Some medications should be taken, others are restricted. It is important to discuss this with your anesthesiologist or your surgeon. Do not interrupt medications unless your anesthesiologist or surgeon recommends it.

These instructions are important for your safety. If you do not follow instructions about not eating or drinking before your surgery, your surgery may be delayed or even cancelled.


What will happen before my surgery?

You will meet your anesthesiologist, and other members of the anesthesia care team, before you go into the operating room. The anesthesiologist will examine you, and review your medical and anesthesia history and the results of any laboratory tests. The anesthesiologist will explain to you the type of anesthesia you will undergo, and will answer any further questions you may have. The anesthetist that you meet prior to surgery may or may not be the anesthesiologist or nurse anesthetist directly delivering your care, however the information that you provide will be directly communicated to your anesthesia care provider prior to your surgery.

Nurses will record your vital signs, and your surgeon or an associate will visit with you, completing any necessary evaluations or paperwork. Intravenous fluids will usually be started and preoperative medications given as needed. Once in the operating room, monitoring devices will be attached such as a blood pressure cuff, EKG and other devices for your safety. At this point, you will be ready for anesthesia.

What will happen during surgery?

Upon arrival to the operating room, you will be greeted by your surgical and anesthesia team. You will either be asked to move to the operating table or you will be moved by the team members present if you require assistance. Once you are on the operating table various monitors will be placed on your body in order to assist with monitoring your vital signs while you are under anesthesia and undergoing your scheduled surgery. Once the appropriate monitors are applied, your anesthesia care team member will begin to administer the type of anesthetic that is most appropriate for you and your scheduled surgery (please see section titled “Types of Anesthesia” for details on the available types of anesthesia).

Once the appropriate anesthetic has been administered, the surgical area will be cleaned and prepared for surgery, and the surgery will be initiated. While you are undergoing surgery, your vital signs and surgery progress will be continuously monitored and documented by a member of the anesthesia care team. Specifically, your blood pressure, heart rhythm and oxygen levels will be most closely followed, and adjustments will be made in order to ensure your safety and comfort.

If you are undergoing a long surgery, your family members will likely receive occasional updates on the progress of your surgery.

Once your surgery is completed, the anesthesia care team member will make the appropriate decisions on the continuation of your care based on various factors, and your surgeon will likely update family members on the status of your surgery.

Recovery from Anesthesia and Surgery

What can I expect after the operation until I go home?

After surgery, you will be taken from the operating room to another area, often referred to as the "recovery room", or post-anesthesia care unit (PACU). Your anesthesiologist will direct the monitoring and medications needed for your safe recovery and to ensure that you are comfortable. For about the first 30-60 minutes, you will be watched closely by specially trained nurses.

After certain kinds of major surgery, you may be taken from the operating room to the intensive care unit for recovery. In these cases you may remain connected to various monitors and life support systems until those support systems are no longer required. Your surgeon and anesthesiologist will discuss this with you or your family.

After the initial recovery period, if you are scheduled to go home after surgery, you may then be moved to another area where you will continue to recover and family or friends may be allowed to be with you. Here you will be offered something to drink and you will be assisted in getting out of bed in order to prepare for your discharge from the hospital.

Will I have any side effects?

The amount of discomfort you experience will depend on a number of factors, especially the type of surgery and overall medical history. Your doctors and nurses can relieve pain after your surgery with medications by mouth or injection or by numbing the area around the incision. Your discomfort should be tolerable, but DO NOT expect to be completely pain-free. Nausea or vomiting may be related to anesthesia, the type of surgical procedure or postoperative pain medications. Although less of a problem today because of improved anesthetic agents and techniques, these side effects continue to occur for some patients.

When will I be able to go home?

This will depend on the type of surgery and the anesthesia used. Most patients who have had outpatient surgery are ready to go home between 1-4 hours after surgery. Your anesthesiologist will be able to give you a more specific time estimate.

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