Epidural

Overview

An epidural is a way of giving strong pain relief through a very thin, soft tube placed in your lower back. The tube sits in a small gap just outside the covering of your spinal cord. That gap is called the epidural space, which is where the name comes from. Numbing medicine flows through the tube, so the lower half of your body feels numb or heavy and pain is blocked. It is used most often in childbirth, for caesarean sections, and for operations on the lower body. You stay awake during an epidural. A specially trained doctor called an anaesthetist sets it up.

Very common. In the UK, about one in three people giving birth in hospital choose an epidural, and many thousands more are given every year for surgery and other reasons. Staff who care for you will have set up hundreds of them.

Anyone who is offered one. That is most often people in labour, people having a caesarean section, and people having an operation on their hips, legs or tummy. It is sometimes used for ongoing back or leg pain, and for rib injuries. Children can have epidurals too, usually for operations, and they are given medicine to help them sleep while the tube is placed.

Symptoms

Common symptoms

• A warm or tingling feeling in your back as the medicine starts to work.
• Heaviness, numbness or 'pins and needles' across your tummy, hips and legs.
• You may still feel pressure or tightening, such as contractions, but not sharp pain.
• Shivering is common and is usually harmless.
• Itchy skin, especially if the mixture includes a strong painkiller.
• A drop in blood pressure, which can make you feel light-headed or sick. Staff check your blood pressure often and can treat this.
• Legs that feel too heavy to move until the medicine wears off.
• A tender or bruised feeling in your back where the tube went in.

Symptoms in children

• Children are usually asleep or heavily settled while the tube is placed, so they do not feel or remember it.
• Afterwards they may have heavy or numb legs and will be watched closely until the feeling comes back.
• Some children feel sick, itchy or shivery as the medicine wears off.
• Tell staff straight away if a child has a bad headache, severe back pain, a high temperature, or legs that stay weak for longer than expected.

Symptoms in older adults

• Age on its own is not a reason to avoid an epidural, but older adults are more likely to take blood-thinning medicines, which the anaesthetist needs to know about.
• Blood pressure can drop more easily, so it is watched closely.
• Narrowing of the spine (spinal stenosis) or past back surgery can make it harder to place the tube.
• Extra help with moving around is often needed until the numb feeling has fully gone.
• A urinary catheter is more often needed until the legs are working normally again.

Causes

Main causes

• An epidural is not an illness — it is a treatment you may be offered. These are the usual reasons it is suggested:
• Pain relief during labour and birth, or numbing for stitches after birth.
• Numbing for a caesarean section, so you can be awake to meet your baby.
• Numbing for operations on the lower body, such as hip or knee surgery.
• Strong pain relief after major surgery, especially on the chest, tummy or bowel.
• Sometimes for ongoing back or leg pain, or for painful rib injuries.

Risk factors

• Taking blood-thinning medicines, or having a health problem that affects how your blood clots.
• A low platelet count (platelets are the cells that help blood to clot).
• An infection on your back, or an infection anywhere in your body.
• Some types of spinal surgery, or an unusual shape to your spine.
• Very low blood pressure, or being seriously dehydrated.
• Raised pressure inside the head (rare).
• Being very overweight can make it harder for the doctor to find the right spot.
• Having had a severe headache or a difficult epidural before.

When to see a doctor

See a doctor urgently if:

• You have a severe headache after an epidural, especially one that is worse sitting or standing.
• Your legs stay weak or numb longer than expected.
• You have a high temperature, severe back pain, or redness and swelling at the injection site.
• You cannot pass urine, or you are leaking urine without control.
• You feel dizzy, faint, or your heart is beating very fast.

Book a routine appointment if:

• You are pregnant and would like to talk through your pain relief options before labour starts.
• You are booked for an operation and want to know what an epidural involves.
• Your back is still tender, or your legs still feel odd, more than a few days afterwards.
• You feel low, anxious or upset about your birth or your epidural experience and want to talk it through.
• You are planning a future pregnancy and want to discuss what happened last time.

Diagnosis

An epidural is a procedure, not an illness, so there is nothing to test for in advance. Before you have one, an anaesthetist (a doctor specially trained in pain relief and sleep medicine) will talk with you. They ask about your health, your medicines and what matters to you, check whether an epidural is safe and suitable, and explain the benefits and risks so the choice is yours. If you have problems afterwards, a doctor will examine you, ask about your symptoms and decide whether any tests are needed.

Tests that may be done

• A conversation about your health, past reactions to pain relief, and all your medicines, including blood thinners.
• Blood tests to check how well your blood clots, if there is any doubt.
• Checks of your blood pressure, pulse and oxygen levels before and during the procedure.
• A look at your back to check for infection, rashes or bruising.
• Afterwards, an examination — and sometimes a scan of your spine — if there are worrying symptoms.

What to expect at your appointment

You will usually sit up and curl forward, or lie on your side with your knees drawn up. First, a small area of skin is numbed with a tiny injection, so the main part should not hurt — you may feel pressure or a strange buzzing sensation. The doctor guides a thin needle into the epidural space and threads the soft tube through it, then removes the needle and tapes the tube to your back. The medicine goes in and starts working in about 20 to 30 minutes. You will be monitored throughout, and may have a drip and, for labour or surgery, a urinary catheter.

Treatment

The epidural itself is the treatment — it is a way of blocking pain rather than a cure for anything. Medicine goes through the tube, either as a single dose or as a steady trickle from a pump, and staff can top it up or adjust it if the pain relief is patchy. If the tube does not work well, the team may reposition it or discuss other options with you.

Self-care at home

• Tell your midwife, nurse or doctor straight away about any new pain, numbness, weakness, headache or fever.
• Ask for help the first few times you get up — your legs may still be weak, even if they feel normal.
• Keep the skin around the tube clean and dry, and check the dressing stays stuck down.
• Drink plenty of fluids, especially if you have a headache, and ask your team what they recommend.
• Once the feeling has fully returned, start moving gently and build up slowly.
• Notice your headache pattern — whether it is worse sitting or standing and better lying flat — and tell your doctor, as this helps them help you.

Medical treatments

Pain relief is given through the epidural tube, and the dose can be adjusted by your team or by a pump you control within safe limits. Staff watch your blood pressure and can treat a drop if it happens. If you develop a bad headache from a leak of spinal fluid, treatment includes rest, fluids, simple pain relief and, if needed, a small procedure called a blood patch. In a blood patch, a tiny amount of your own blood is placed near the puncture to seal it. If you decide against an epidural, other options include breathing and relaxation techniques, a pain-relief gas you breathe through a mask, and injections of painkillers. Your team can explain what is available where you are.

When is surgery considered?

An epidural is not an operation. It is often used during surgery on the lower body, or to control pain after major surgery. Rarely, a small procedure such as a blood patch is needed afterwards to seal a leak of spinal fluid if you get a severe headache.

Living with this condition

Most people feel back to normal within a day or two. The numb feeling usually fades within a few hours of the medicine being stopped, though heavy legs can last longer. Your back may be tender or bruised where the tube went in, and this settles with time. If you had a headache after a dural puncture, it can take a few days to a week to clear, and your doctor can offer treatment in the meantime.

Lifestyle tips

• Build your activity back up gradually rather than all at once.
• Avoid heavy lifting, strenuous exercise and long drives until any numbness has gone and you feel fully yourself — ask your team when it is safe.
• Keep eating and drinking normally once you are not in labour; during labour, ask your midwife what light food and drink is allowed on your unit.
• Use a warm pack on a tender back if it helps, but protect the skin and follow any advice from your team.
• Get plenty of rest, especially in the first few days after birth or surgery.
• Ask family and friends for practical help so you can recover at your own pace.

Diet and exercise

There is no special diet after an epidural. Eat and drink normally, and take extra fluids if you have a headache. During labour, many units allow light food and clear drinks — ask your midwife what is right for you. Once the feeling in your legs has fully returned, start with short walks and gentle stretching, then build up over a week or two. Wait until you feel fully recovered before returning to vigorous exercise, and ask your GP or midwife if you are unsure.

Mental health and emotional wellbeing

It is common to have strong feelings about an epidural. Some people feel relieved, others feel disappointed or upset if it did not work as they hoped, or if the experience felt out of their control. Some feel shaken by the memory for a while. These feelings are valid, and talking them through really helps. If low mood, anxiety, flashbacks or upsetting memories last more than a couple of weeks, or if they affect your sleep, your eating or how you feel about your baby, please tell your midwife, health visitor or GP. Support is available and you are not being a nuisance. If you ever have thoughts of harming yourself or ending your life, contact your local emergency number or a crisis line in your country straight away.

Prevention

An epidural is a choice, not an illness, so there is nothing to prevent. What you can do is prepare well. Talk through your options before labour or before surgery, tell the team about all your medicines — especially blood thinners — and any health conditions, and ask questions until you feel clear. If you have had a difficult epidural or a bad headache before, say so early, as this can change the plan. Knowing what to expect, and what warning signs to watch for, is the best way to stay safe and feel in control.

Complications

If left untreated

• An epidural is optional, so 'untreated' does not really apply — if you choose not to have one, your pain will be managed in other ways.
• A drop in blood pressure during or after the procedure can make you feel faint or sick; staff watch for this and treat it.
• The block may be patchy or one-sided, so pain relief is not complete.
• A headache from a dural puncture (the needle nicks the covering of the spinal cord) happens in roughly 1 in 100 epidurals. It usually settles and can be treated with a blood patch.
• Temporary numbness, tingling or a sore back for a few days is fairly common.
• Nerve injury is rare, and most people recover fully.
• Very rarely, an infection or a collection of blood near the spine can occur — this needs urgent treatment, which is why warning signs matter.
• Very rarely, the block can spread too high and affect breathing; staff are trained to spot and manage this quickly.

Long-term outlook

The outlook is good for the great majority of people. Epidurals are one of the most widely used and best-studied ways of relieving pain, and serious problems are uncommon. Most side effects are mild and short-lived. If something does not feel right afterwards — a stubborn headache, weakness, or a fever — speak up early, because most problems are easier to sort out when they are checked promptly.

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