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Epidurals for surgery and pain relief

Expert reviewer, Dr Ahmed Almaki, Consultant Anaesthetist
Next review due January 2025

An epidural is an injection of medicines into your back, which stops you feeling pain in the lower half of your body. It’s used during surgery, often with a general anaesthetic. It can also be used for pain control during and after an operation or procedure.

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.

What is an epidural?

Epidural anaesthesia is a type of regional anaesthesia. It 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.

An epidural is usually used for operations which are expected to take longer than two hours. You may also have an epidural if you need pain relief for several days.

Your anaesthetist uses 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 anaesthetic comes from. The catheter delivers 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 usually relieves pain in your pelvic area and legs. 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, such as those on your womb or ovaries
  • surgery on your prostate or bladder
  • surgery on the lower part of your abdomen (tummy), such as the repair of a hernia

You can also have an epidural with spinal anaesthesia and with a general anaesthetic. This can help to improve pain relief for you.
An epidural catheter can be left in for some time after your operation. This 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.

Reasons for having 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 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.

Alternatives to having an epidural

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 to 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.

Preparing for an epidural

Your anaesthetist will discuss what will happen before, during and after your epidural. They will give you information about the risks and benefits of any options. If you’re unsure about anything, ask. No question is too small. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You may be asked to do this by signing 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.

Having an epidural

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.

You’ll be asked 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.

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 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.

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.

There is usually a cloth screen 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 would normally only stay in for a few days at most.

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. 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 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 are sure the anaesthetic is working well.

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.

After 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 a few hours after the last dose of medicine through the epidural. It can take up to 18 hours for everything to feel normal again. 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.

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.

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 (pass urine). This can happen if the nerves to your bladder are affected by the epidural. You might need to have a catheter until the effects of the epidural wear off. This is a thin tube that drains pee (urine) from your bladder and 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. This happens quite often, so you’ll have your blood pressure checked 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.
  • 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.

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    • Epidural Nerve Block. Medscape. emedicine.medscape.com, updated 10 Aug 2021
    • Regional anesthesia for postoperative pain control in orthopedic surgery – overview. Medscape. emedicine.medscape.com, updated 30 April 2019
    • Anaesthesia explained. Royal College of Anaesthetists. www.rcoa.ac.uk, published 1 March 2021
    • Nerve damage associated with a spinal or epidural injection. Royal College of Anaesthetists. www.rcoa.ac.uk, published 2017
    • Epidural pain relief after surgery. Royal College of Anaesthetists. www.rcoa.ac.uk, published February 2020
    • Patient FAQs. Royal College of Anaesthetists. www.rcoa.ac.uk, accessed 1 December 2021
    • Anim‐Somuah M, Smyth RMD, Cyna AM, et al. Epidural versus non‐epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews 2018 (5). Art. No.: CD000331. DOI:10.1002/14651858.CD000331.pub4
    • Best practice in the management of epidural analgesia in the hospital setting. The Faculty of Pain Medicine of the Royal College of Anaesthetists. fpm.ac.uk, published August 2020
    • Morphine. British National Formulary. bnf.nice.org.uk, accessed 3 December 2021
    • McNicol ED, Ferguson MC, Hudcova J. Patient controlled opioid analgesia versus non‐patient controlled opioid analgesia for postoperative pain. Cochrane Database of Systematic Reviews 2015 (6). Art. No.: CD003348. DOI: 10.1002/14651858.CD003348.pub3. www.cochranelibrary.com, accessed 03 December 2021
    • AAGBI: Consent for anaesthesia 2017. The Association of Anaesthetists of Great Britain & Ireland. www.rcoa.ac.uk, published January 2017
    • Patient FAQs. Royal College of Anaesthetists. www.rcoa.ac.uk, accessed 8 December 2021
    • Important Complications of Anaesthesia. Patient. patient.info, last edited 28 Jun 2019
    • Headache after a spinal or epidural injection. Royal College of Anaesthetists. www.rcoa.ac.uk, published 2015
    • Personal communication. Dr Ahmed Almaki. Consultant Anaesthetist, 24 January 2022
  • Reviewed by Sarah Smith, Freelance Health Editor, and Abbey Stanford, Specialist Health Editor, Bupa Health Content Team, January 2022
    Expert reviewer Dr Ahmed Almaki, Consultant Anaesthetist
    Next review due January 2025

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