Epidurals for surgery and pain relief

Expert reviewer, Dr Ahmed Almaki, Consultant Anaesthetist
Next review due July 2022

An epidural is an injection of medicines into your back to stop you feeling pain in the lower half of your body. If you’re having certain surgical procedures, you may be offered an epidural alone, or together with a general anaesthetic. The epidural may be continued after your procedure to relieve any pain.

This topic covers epidural injections that you’ll have during, and sometimes after, an operation. We have separate information about epidural injections for lower back and leg pain.

Image showing where the epidural is positioned

What is an epidural?

Epidural anaesthesia is a type of regional anaesthesia, which stops you feeling pain in part of your body without making you go to sleep. It’s carried out by a specialist doctor called an anaesthetist.

Your anaesthetist uses a needle to put a small plastic tube (called a catheter) into the area around your spinal cord in your back. This area is called the epidural space, which is where the name of this type of anaesthetic comes from. This catheter allows medicines to be delivered directly around your spinal nerves as they leave your spinal cord.

The types of medicine usually given as an epidural include local anaesthetics and sometimes other pain-relieving medicines. These will temporarily block the feeling in your body below the site of the injection, usually in your pelvic area and legs. Your anaesthetist can control how much feeling you lose by selecting the amount, strength and type of medicine they use.

You can have epidural anaesthesia instead of general anaesthesia for some types of surgery, such as surgery on your pelvis or legs. Or you can have a combination of an epidural and a general anaesthetic to improve pain relief.

The epidural can be left in for a few days after your operation with the medicines being topped up to give you continuing pain relief. You might be given control of the infusion, which is called patient-controlled epidural analgesia (PCEA). You control the flow of medicine by pressing a button on an epidural pump.

Why have 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. This means you’ll avoid the possible side-effects of a general anaesthetic, such as feeling sick, or getting a sore throat or a chest infection.
  • If you do have general anaesthesia, having an epidural as well might mean you need less of the general anaesthetic medicine. This can help you recover better afterwards.
  • If the epidural continues after your operation, you won’t need so many other painkilling medicines. This means you’ll be less likely to feel sick, you’ll be more alert and your breathing will be better.
  • Epidural anaesthesia may reduce the amount of blood you lose during surgery compared to general anaesthesia.
  • There may be a lower risk of deep vein thrombosis (DVT) compared to general anaesthesia.

If your anaesthetist offers you an epidural, it’s your decision whether to have one. Ask them to explain what the benefits and potential risks of this type of anaesthetic are for you in your particular circumstances. For more information, see our sections on Side-effects and complications of epidurals below.

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.

Alternatives to having an epidural

Alternatives to having epidural anaesthesia for surgery include:

  • spinal anaesthesia, in which your anaesthetist will inject local anaesthetic directly into the fluid that surrounds the spinal nerves in your lower back
  • general anaesthesia, which means you're asleep during the operation

An alternative to an epidural for pain relief immediately after your operation is to have a painkilling medicine, such as morphine. Your anaesthetist may give you morphine by mouth or into a vein. 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.

Preparing for an epidural

Your anaesthetist will discuss with you what will happen before, during and after your epidural. They will give you details of the risks and benefits of any options. Feel free to ask as many questions as you need to. You’ll need to give your consent for the procedure to go ahead. You’ll usually do this by signing a consent form.

If you’re having an epidural without general anaesthesia, you’ll stay awake during the procedure, but your anaesthetist may also offer a sedative to help you relax. This will make you feel sleepy.

What happens during an epidural

Your anaesthetist will explain what they’re going to do, and what you might expect to feel. They’ll probably 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.

You’ll be asked to lie on your side, draw your knees up to your tummy and tuck your chin in. Or they might ask you to sit up on the bed and lean forward, perhaps holding a pillow.

Your anaesthetist will clean the skin on your back with a sterilising solution and give you an injection of local anaesthetic to numb the area.

Once your skin is numb, your anaesthetist will pass a larger, hollow epidural needle into the epidural space. When the needle reaches the right spot, they’ll put a 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 inserting the epidural needle. They’ll tell you when this is. Let them know if you feel any pain – 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 into the epidural space. They might attach a pump to the catheter to give a continuous infusion of medicines. Or you might have top-up medicines given through the catheter after your operation.

When you no longer need epidural pain relief, your anaesthetist will carefully remove the catheter and cover the area with a plaster. You won’t normally have an epidural left in for longer than a few days.

What does having an epidural feel like?

You’ll feel a sting when the local anaesthetic injection goes into your skin. After that you’ll feel your anaesthetist pushing, but usually there isn’t any more discomfort as the needle and catheter go in. Sometimes, there’s a sharp ‘shock-like’ feeling or a brief tingling down one leg as the catheter touches a nerve. Tell your anaesthetist if this happens.

As the epidural takes effect, you’ll gradually get a feeling of warmth and numbness. In some cases, your legs may feel heavy and difficult to move.

It shouldn’t feel uncomfortable when the epidural is taken out. The sticky plaster holding the catheter in place is removed and the catheter carefully pulled out. It only takes a few seconds.

What to expect after an epidural

After an epidural, you’ll need to rest until the effects of the anaesthetic have worn off. Your legs may be weak and feel numb for a while – so don’t try to stand until your doctor or nurse says you can. The feeling and movement should return to normal within a few hours after the last dose of medicine through the epidural. You may feel some tingling as the sensation comes back. Tell your nurse if you’re in any pain.

If you have a pump connected to your epidural, your nurse will check this regularly to make sure it’s working properly.

It might be sore where your anaesthetist put the needle in your back and you might have a bruise, but this usually settles. Sometimes, your anaesthetist might need to remove your epidural catheter tube and put it back in again to make it more comfortable for you.

If you have backache after your operation this might just be caused by lying on the flat operating table. But if it gets worse, contact your surgeon or the hospital. And contact them if you start to feel weak, numb, or have any problems with your bladder or bowels.

You shouldn’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 use a catheter until the effects of the epidural wear off. A catheter drains urine from your bladder through a thin tube and into a bag outside your body.
  • Feeling sick and vomiting, but this is less common after an epidural than after a general anaesthetic.
  • A drop in your blood pressure. Nurses will check this regularly. If it drops, you might be given fluids and medicines to raise it back up to normal.
  • Losing strength or control of your muscles. You might not be able to move your legs or arms, depending on where you had the epidural. This will soon wear off once the effects of the medicine you are given wear off.
  • Pain. Sometimes the epidural doesn't relieve pain as expected and you might need to have a top-up dose or use another method of pain relief.
  • 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 may puncture the membrane that covers your spinal cord and the fluid inside can leak out. This means there’s less fluid around your brain, which can give you headaches. These may be worse when sitting or standing up. Some people require no other treatment than pain medication and bed rest. Or your anaesthetist may treat this with a ‘blood patch’, which involves them injecting some of your own blood into your back. The blood clots seal the hole.
  • An infection. This is rare because your anaesthetist will clean your skin before they put the sterile needle in your back. If you get an infection, you’ll probably need to have antibiotics.
  • Bleeding. Very rarely, blood clots can form in the epidural space, which can cause a permanent injury if not noticed. You’ll be monitored to reduce this risk to a minimum.
  • Nerve damage. You might lose the feeling in part of your body. In most people, this gets better after a few days, weeks or months. Rarely, it may 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.

If you have any questions about possible complications, or how they may relate to you in your particular circumstances, ask your anaesthetist.

Frequently asked questions

  • As well as local anaesthetics that numb your nerves, you might be given medicines called opioids (such as morphine or fentanyl) to relieve pain. In an epidural, they can be used alone or in combination with a low dose of local anaesthetic. Local anaesthetics and opioids work together so that lower doses of each can be used to reduce side-effects.

  • If you have an epidural as well as a general anaesthetic, you’ll be asleep during your operation. This means you won’t be aware of what’s going on.

    If you have an operation under epidural anaesthesia alone, you’ll stay awake. But you may be sleepy or drowsy if you have sedation too. You won't feel anything from your waist down or the area covered by the epidural injection, but you may get a sensation of pushing or pulling during the operation.

    Since you’ll be awake, you may be able to hear the sound of medical staff moving around and talking. And you may hear the sounds of the equipment monitoring you. You won’t be alone – your anaesthetist will be there if you want to speak to them. If you’d prefer not to hear anything, ask a nurse if you can listen to music through headphones.

    There’ll usually be a cloth screen to hide the area being operated on, so you won't be able to see what your surgeon is doing. For some procedures, you may be able to watch the operation on a video monitor if you want to.

    Having a sedative before your operation to help you relax can affect how much you remember afterwards. You may not remember anything.

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Related information

    • Epidural nerve block. Medscape., updated October 2017
    • Regional anesthesia for postoperative pain control in orthopedic surgery. Medscape., updated April 2019
    • Practical local anaesthesia. PatientPlus., last edited December 2015
    • Post-operative pain. OSH Post-operative complications (online). Oxford Medicine Online., published October 2011
    • Epidural pain relief after surgery. Royal College of Anaesthetists, 2014.
    • Anaesthesia explained. Royal College of Anaesthetists, 2015.
    • Best practice in the management of epidural analgesia in the hospital setting. Royal College of Anaesthetists, 2010.
    • Risks associated with your anaesthetic. Nerve damage associated with a spinal or epidural injection. Royal College of Anaesthetists, 2017.
    • Risks associated with your anaesthetic. Headache after a spinal or epidural injection. Royal College of Anaesthetists, 2015.
    • Regional anesthesia for surgery. American Society of Regional Anesthesia and Pain Medicine., accessed July 2019
    • Personal communication, Dr Ahmed Almaki, Consultant Anaesthetist, July 2019

  • Reviewed by Dr Kristina Routh, Freelance Health Editor, July 2019
    Expert reviewer, Dr Ahmed Almaki, Consultant Anaesthetist
    Next review due July 2022