Risks and benefits of epidural anaesthesia

Overview

An epidural is a type of pain relief (anaesthesia) that numbs the lower half of your body. A thin tube is placed in your back near the nerves that carry pain signals. Medicine flows through the tube to block pain, usually during surgery or childbirth. It is very safe, but like any medical procedure it has both benefits and risks.

Yes, epidurals are widely used and very common, especially for childbirth and certain surgeries like hip or knee replacements.

Anyone having surgery on the lower half of the body (legs, hips, pelvis, or abdomen) or who wants pain relief during labour. Your anaesthetist will decide if it is right for you.

Symptoms

Common symptoms

• Numbness and loss of feeling in the lower body during the procedure
• Temporary difficulty moving your legs while the epidural is working
• A small drop in blood pressure, which may make you feel lightheaded
• Mild headache or backache after the epidural wears off

Symptoms in children

• Epidurals are rarely used in children; if they are, the child may feel anxious or confused about the numbness.

Symptoms in older adults

• Older adults may experience more dizziness or a greater drop in blood pressure.
• They might take longer to regain full feeling and movement.

Causes

Main causes

• Epidural anaesthesia is given for pain relief during surgery or labour. It is not a disease but a medical choice.
• The nerve block works by stopping pain signals from reaching your brain.

Risk factors

• Having a bleeding disorder or taking blood-thinning medicines (increases risk of bleeding around the spine)
• Having an infection near the injection site (may increase risk of meningitis or abscess)
• Being very overweight or having spinal abnormality (may make placement more difficult)
• Previous back surgery or spinal conditions

When to see a doctor

See a doctor urgently if:

• If you develop a severe headache that does not improve after lying down
• If you have any sign of infection at the back where the needle went in (redness, swelling, pus)
• If you cannot pass urine within 8 hours after the epidural stops

Book a routine appointment if:

• To discuss any concerns before your procedure – your anaesthetist will explain the risks and benefits specific to you.

Diagnosis

If you have a complication, your doctor will take your history and examine you. They may check your vital signs, muscle strength, and sensation.

Tests that may be done

• Blood pressure and heart rate monitoring
• Neurological exam (checking your ability to move and feel)
• MRI or CT scan if a spinal infection or bleeding is suspected

What to expect at your appointment

Your anaesthetist will talk to you before the procedure about what will happen. During the epidural you will be numb from the waist down. After it wears off, you will gradually regain feeling and movement.

Treatment

Treatment for complications of an epidural depends on the problem. Most side effects are mild and go away on their own. Serious issues are treated by a specialist team.

Self-care at home

• For a mild headache: lie flat, drink plenty of fluids, and rest.
• For mild backache: apply a warm compress and take it easy for a day.
• If you have numbness or weakness, wait until it fully resolves before driving or operating machinery.

Medical treatments

A severe headache from a dural puncture may be treated with a blood patch (injecting a small amount of your own blood near the puncture site to seal the leak). Infections are treated with antibiotics. Bleeding around the spine may require surgery.

When is surgery considered?

Surgery is rarely needed, but may be required if there is a large blood clot or abscess pressing on the spinal cord.

Living with this condition

After an epidural, you will likely need to stay in bed for a few hours until sensation returns. Once it wears off completely, you can resume normal activities. You may feel a bit sore at the injection site for a day or two.

Lifestyle tips

• Avoid driving until you have full control of your legs and feet.
• Do not lift heavy objects for a few days if you had back surgery.
• Follow your surgeon or midwife's advice about activity restrictions based on your procedure.

Diet and exercise

There are no special diet or exercise restrictions after an epidural itself. Eat and drink normally unless your surgery requires fasting. Gentle walking is fine once you feel ready.

Mental health and emotional wellbeing

It is common to feel anxious before the procedure. Remember that the epidural is there to help you feel less pain. If you feel worried, talk to your healthcare team – they can explain everything and offer reassurance.

Prevention

You can reduce the risk of complications by telling your anaesthetist about all medicines you take, including blood thinners, and about any back problems or infections. Always follow pre-procedure instructions.

Complications

If left untreated

• A severe headache if a dural puncture is not sealed can be debilitating and last days or weeks.
• An infection near the spine (meningitis or abscess) can lead to nerve damage if not treated quickly.
• Bleeding around the spine (spinal haematoma) can cause permanent paralysis if not surgically relieved.

Long-term outlook

Most epidurals are very safe and work well. Serious complications are extremely rare – specialists place millions of epidurals every year. If a complication does occur, treatment is usually effective. Your healthcare team will monitor you closely to catch any problems early.

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