OBSTETRIC ANESTHESIA QUESTIONS:
I am nervous about my cesarean; can I be asleep for it?
General anesthesia has added risks for mom and baby compared with spinal anesthesia, which include the risk of aspiration of fluid and solids from your stomach into your lungs. Therefore, we put you to sleep only in unique situations and emergencies.
Will I get back pain from a spinal or epidural?
Spinals and epidurals do not cause long-term back pain. You may have mild bruising and tenderness where the spinal or epidural is placed that can last a few days.
hOW LONG DOES AN EPIDURAL LAST?
Once the catheter is in place, the anesthetist can set up an epidural pump. The pump feeds the epidural solution into the catheter continuously, providing pain relief for as long as needed. The type, amount and strength of the anesthetic can be adjusted, as necessary. You might also be given the option of having control of the medication pump. This is called patient controlled analgesia. The amount of painkiller is still regulated, so you can’t accidentally overdose. You can have the dose lowered for second stage pushing, but it takes some time for the pain relief and numbness to wear off, so if this is important to you, discuss it with your care provider early on.
wHAT IS AN epidural?
Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to a total lack of feeling. Epidurals block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body. Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics such as fentanyl and sufentanil in order to decrease the required dose of local anesthetic. This produces pain relief with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure.
HOW IS AN EPIDURAL GIVEN?
Intravenous (IV) fluids will be started before active labor begins and prior to the procedure of placing the epidural. You can expect to receive 1-2 liters of IV fluids throughout labor and delivery. An anesthesiologist (specialize in administering anesthesia), an obstetrician or nurse anesthetist will administer your epidural.
You will be asked to arch your back and remain still while lying on your left side or sitting up. This position is vital for preventing problems and increasing epidural effectiveness.
wHAT ARE THE DIFFERENT TYPES?
There are two basic epidurals in use today. Hospitals and anesthesiologists will differ on the dosages and combinations of medication. You should ask your care providers at the hospital about their practices in this regard.
After the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. A narcotic such as fentanyl or morphine is given to replace some of the higher doses of anesthetic, like bupivacaine, chloropropane, or lidocaine.
This helps reduce some of the adverse effects of the anesthesia. You will want to ask about your hospital’s policies about staying in bed and eating.
Combined Spinal-Epidural (CSE) or “Walking Epidural”
A spinal block is sometimes used in combination with an epidural during labor to provide immediate pain relief. A spinal block, like an epidural, involves an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. It brings good relief from pain and starts working quickly, but it lasts only an hour or two and is usually given only once during labor. The epidural provides continued pain relief after the spinal block wears off.
What will i experience during my epidural placement?
wHAT ARE THE BENEFITS OF EPIDURAL ANESTHESIA?