Epidurals for surgery and pain relief
- Dr Tharaka Wijerathne, Consultant Anaesthetist
An epidural is an injection of medicines into your back. It stops you from feeling pain in the lower half of your body. Epidurals are used during surgery, often with a general anaesthetic. An epidural can also be used for pain control during and after an operation or procedure.
This topic covers epidural injections that you may have during, and sometimes after, an operation. We have separate information about epidural injections for lower back and leg pain.
How an epidural is given
What is an epidural? | the procedure - watch in 1 minute 37 seconds
An epidural is an injection into your lower back to temporarily block pain from your waist down. This video describes how an epidural is given.
An epidural is an injection into your lower back that temporarily blocks pain from your waist down.
You'll be asked either to lie on your side with your knees tucked into your chest, or to sit upright and lean forward.
This opens up the space between the bones in your spine.
Your anaesthetist will carry out your epidural in two parts.
Firstly, a small amount of local anaesthetic is injected into your skin to completely numb the area.
Then, a hollow epidural needle is given into your epidural space.
This is the space just outside the membranes that surround your spinal cord.
When the epidural needle reaches the correct spot, your anaesthetist will thread a very thin plastic tube through the centre of the hollow needle.
They'll then remove the epidural needle, leaving just the tube in place.
The tube will run from inside your epidural space to the outside of your body.
It's secured using adhesive tape and used by your anaesthetist to give you medicines for pain relief when you need them.
Your anaesthetist may also attach a pump to the tube so you can top up your pain relief when needed, and sometimes you'll be able to control this yourself.
When you no longer need pain relief, the tube will be carefully removed and the area covered with a plaster.
About epidurals
Epidural anaesthesia is a type of regional anaesthesia. It stops you from feeling pain in part of your body without making you go to sleep. It’s carried out by a specialist doctor called an anaesthetist.
Whether or not you have an epidural will depend on such things as:
- how complex your operation is
- the type of surgery involved
- how much pain you’re likely to have after the procedure
You may have an epidural if you need pain relief for a few days.
Your anaesthetist will use a needle to put a small plastic tube (called a catheter) into the area around the spinal cord in your back. This area is called the epidural space, which is where the name of this type of anaesthesia comes from. The catheter will deliver anaesthetic medicines directly to the area around your spinal nerves.
The medicines usually given as an epidural include local anaesthetics and sometimes other strong painkillers called opioids. These will temporarily block the feeling in your body below the place where the injection is put in. This is usually to relieve pain in your pelvic area and legs, or your chest or tummy (abdomen). Your anaesthetist can control how much feeling you lose by adjusting the amount, strength and type of medicine they use.
You can have epidural anaesthesia instead of general anaesthesia for some types of surgery. This includes for:
- surgery on your pelvis, hips or legs
- a caesarean section
- gynaecological operations on the womb or ovaries
- surgery on your prostate or bladder
- surgery on the lower part of your tummy (abdomen) – for example, repair of a hernia
You can also have a combination of an epidural with spinal anaesthesia or with general anaesthesia. This can help to improve pain relief for you.
An epidural catheter can be left in for some time after your operation, which means you can have continuous pain relief. You might be given a button to push which gives you control of your pain relief.
Epidurals can also be used as pain relief before and after labour, and while your baby is being born.
Preparation for an epidural
Your anaesthetist will discuss what will happen before, during, and after your epidural. They’ll give you information about the risks and benefits of any options. If you’re unsure about anything, ask. No question is too small. If you have all this information, it can help to put you more at ease and will enable you to give your consent for the procedure to go ahead. Your anaesthetist or nurse will ask you to sign a consent form.
If you’re having an epidural without general anaesthesia, you’ll stay awake during the procedure. Your anaesthetist may also give you a sedative to help you relax. This should make you feel sleepy and relaxed.
Uses of an epidural
Your anaesthetist may recommend you have an epidural for several reasons.
- Having an epidural might mean you don’t have to have a general anaesthetic.
- If you have a general anaesthetic with an epidural, you may need less of the general anaesthetic medicine. This may help your recovery afterwards by reducing the chance of some complications.
- If the epidural continues after your operation, you’re less likely to need other strong painkillers. This means you’ll be less likely to feel sick, you’ll be more alert, and your breathing will be better.
- An epidural may reduce the amount of blood you lose during your operation, compared to having a general anaesthetic.
- You may be less likely to have a deep vein thrombosis (DVT), compared to having a general anaesthetic.
- If your anaesthetist offers you an epidural, it’s your choice whether or not to have one. Ask them to explain what the possible benefits and risks are for you.
An epidural isn’t suitable for everyone. If you’ve had an operation on your back before or have a blood clotting problem, it might not be the best option. Tell your anaesthetist if you’re taking any blood-thinning medicines such as warfarin.
The epidural procedure
Your anaesthetist will explain what they’re going to do, and what you might expect to feel. They’ll start by using a needle to put a fine plastic tube (a drip) into a vein in your hand or arm. This lets them give you fluid if you need it during your operation.
They’ll ask you to lie on your side or sit up. You’ll need to bend forwards or curl up so that your back is as curved as it can be. The anaesthetist will clean the skin on your back using an antiseptic. Then you’ll have a small injection of local anaesthetic to numb the skin.
Once your skin is numb, your anaesthetist will put a larger needle into the epidural space in your back. When the needle reaches the right spot, they’ll put a thin flexible tube (catheter) through the needle. Your anaesthetist will then remove the needle, leaving the catheter behind. They’ll use some tape to hold the catheter in place.
It's really important to stay still when your anaesthetist is putting the epidural needle in. Let them know if it hurts or if you feel any tingling sensations. This will help your anaesthetist to give you the epidural safely.
Your anaesthetist will inject local anaesthetic and/or other pain-relieving medicines through the catheter. They might attach the catheter to an infusion pump to give the medicines continuously. Or you might have another dose of medicines given through the catheter after your operation.
Your anaesthetist will use an icy-cold spray, or prick your skin with a pin to check that you’re body is numb before your surgeon starts your surgery.
During the operation you might feel a sensation of pushing or pulling. Since you’ll be awake, you may hear the medical staff moving around and talking or the equipment making noises. You won’t be alone – your anaesthetist will be there if you want to speak to them.
A cloth screen is usually put up to hide the area being operated on. You won't see what your surgeon is doing unless you want to.
When you don’t need pain relief anymore, your anaesthetist will take out the catheter. An epidural catheter would normally only stay in place for a few days at most.
What having an epidural feels like
You’ll feel a sting when the local anaesthetic injection goes into your skin. After that you’ll feel your anaesthetist pushing. It can sometimes take more than one go for the anaesthetist to get the catheter in the right place. This can be a bit uncomfortable but it shouldn’t hurt.
Sometimes, there’s a sharp ‘shock-like’ feeling. Your anaesthetist will probably notice this happening but if not, tell them.
As the epidural medicine starts to work, you’ll gradually get a feeling of warmth and numbness. Your legs may feel heavy and difficult to move as well. The pain relief and numbness last for as long as the epidural is in place. Your surgeon won’t start the operation until they’re sure the anaesthetic is working well.
It shouldn’t feel uncomfortable when your anaesthetist takes the epidural catheter out. They’ll remove the tape that’s holding it in place and carefully pull the catheter out. This only takes a few seconds.
Aftercare following an epidural
After an epidural, you’ll need to rest until the effects of the anaesthetic have worn off. Your legs may be a bit unsteady for a while.
The feeling and movement should return to normal within anything from one to 18 hours after the last dose of medicine through the epidural catheter. It will depend on the type of medicine you have in the epudural. Tell your nurse if you’re in any pain.
If you have a pump connected to your epidural catheter, your nurse will check this regularly to make sure it’s working properly.
`If you have backache after your operation this might be caused by lying on the flat operating table. But if it gets worse, contact your surgeon or the hospital. You should also contact them if you start to feel weak, numb, or have any problems with your bladder or bowels.
Don’t drive, operate machinery or drink alcohol for 24 hours after having an epidural.
Side-effects of an epidural
Side-effects are the unwanted, but mostly temporary effects of a successful procedure. Common side-effects of an epidural include the following.
- Not being able to pee. This can happen if the nerves to your bladder are affected by the epidural. You might need to have a catheter into your bladder until the effects of the epidural wear off. This is a thin tube that drains pee (urine) from your bladder into a bag outside your body.
- Feeling sick and being sick. This is less likely to happen after an epidural than after a general anaesthetic.
- A drop in your blood pressure. Your anaesthetist or specialist nurse will check your blood pressure regularly. If it drops, you might be given fluids and medicines to bring it back up.
- Losing strength or control of your muscles. Your legs might feel heavy and hard to move. This should wear off once the epidural is stopped.
- Pain. Sometimes the epidural doesn't work as well as expected. You might need to have a top-up dose or use another type of painkiller. Or your anaesthetist may need to give you an epidural in a slightly different location in your back.
- Itchy skin. This can be treated with medicines if you need them.
Complications of an epidural
All medical procedures, no matter how safe, carry some risk of complications. This is when problems occur during or after the procedure. Possible complications of an epidural include the following.
- A headache. The epidural injection can make a hole in the bag of fluid around your spinal cord. The fluid inside can then leak out. This means there’s less fluid around your brain, which is what gives you headaches. They can feel like a bad migraine and get worse when you’re sitting or standing. The headache often gets better if you lie flat, drink plenty of fluid and take painkillers. If that doesn’t work, your anaesthetist may inject a small amount of your own blood into your back. The blood clot seals the hole.
- An infection. This is rare, but if you get an infection, you’ll probably need to have antibiotics.
- Bleeding. Very rarely, blood clots can form in the epidural space This can cause a permanent injury if it’s not noticed. You’ll be monitored closely to prevent this from happening.
- Nerve damage. This can range from numbness and pins and needles through to being unable to move or have control over your bladder and bowels. In most people, this gets better after a few days, weeks, or months. Rarely, it can be permanent.
- Difficulty breathing. Some medicines used in epidurals can make your breathing slow or make you drowsy. You’ll have treatment if this happens.
Alternatives to having an epidural
Epidurals aren’t suitable for everyone. Alternatives to having epidural anaesthesia for surgery include the following.
- Spinal anaesthesia. This is when a local anaesthetic is injected directly into the fluid around the spinal nerves in your lower back.
- General anaesthesia. This is when you're asleep during the operation.
- A nerve block. This is an injection of local anaesthetic given near a nerve or group of nerves. Nerve blocks can be used as pain relief both during and after an operation.
You can also have a strong painkilling medicine such as morphine after an operation. Your anaesthetist can give you morphine as a tablet or liquid to swallow, or as an injection. You may be able to have morphine given through an intravenous drip which you control. This is called patient-controlled analgesia (PCA).
Ask your anaesthetist to talk to you about your options for pain relief.
When the anaesthetist puts local anaesthetic into your skin to numb it, it can sting a bit. After that, it may feel a bit uncomfortable, but it shouldn’t hurt. You might feel the anaesthetist pushing as they put the epidural needle in.
You can find out more in our section on what having an epidural feels like.
You might be offered an epidural if you’re having an operation on the lower part of your body. This includes surgery on your pelvis, legs or lower tummy (abdomen). An epidural can also be used if you’re having gynaecological surgery or a caesarean section.
You can read more about surgery and epidurals in our section, About epidurals.
You can have an epidural for pain relief during and after an operation. An epidural catheter can stay in for a few days after your operation to give you continuous pain relief. Epidurals can also be used to relieve your pain during labour and the birth of your baby. We have separate information about epidural injections for lower back and leg pain.
There’s more information about pain management in our section, About epidurals.
Feeling and movement usually comes back within a few hours of your anaesthetist stopping the epidural. But, depending on the type of anaesthetic, it can take up to 18 hours for everything to feel normal again. Tell your nurse if you need other painkillers.
You can find out more in our section on aftercare following an epidural.
General anaesthesia
General anaesthesia is when medication is given to make you temporarily unconscious during an operation, so don't feel pain or other sensations.
Epidural injections for lower back, leg pain
Sometimes spinal injections (epidural or nerve root injections) are used to treat chronic back and leg pain.
Local anaesthesia
Local anaesthesia involves numbing a small part of your body with a medicine called a local anaesthetic to stop pain during and after surgery.
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- Rachael Mayfield-Blake, Freelance Health Editor
