Epidural anesthesia: making an informed choice. Epidural anesthesia consequences

If you gave birth with, you will probably respond enthusiastically about it, if you plan to give birth with it, and the decision has already been made, you will also defend this type of pain relief. Most likely, only those who gave birth safely without any anesthesia will remain indifferent.

But if we don’t talk only about the benefits of this type of pain relief, but look a little deeper, is this method of reducing the sensitivity of the body really that safe? The consequences are often not discussed.

We will not touch on the complications of this process, such as infection, the development of a hematoma, a complete spinal block and other horrors that are indeed very rare. Now statistics show only one severe complication per 80 thousand births. We will talk about “minor” consequences, with a completely smooth operation.

This technique has been studied quite widely; extensive randomized studies have been conducted, including thousands of women who have given birth. It turned out that epidural or peridural anesthesia affects the course of labor, the condition of the mother, and the health of the child.

Consequences of epidural anesthesia during childbirth

• According to research conducted back in 1993 by Thorp et. al, frequency caesarean section when using epidural anesthesia it increases 12 times! Women are often simply unable to give birth on their own, and an unplanned cesarean section becomes such an unexpected consequence. Statistically, more than half of women who are insensate during labor end up giving birth by Caesarean section.
• The duration of both the first stage of labor and the period of expulsion increases compared to women in labor in whom anesthesia was not used. This forces us to more often resort to stimulation of labor and the use of oxytocin, as well as to use instrumental methods vaginal delivery (application of a vacuum extractor). It is important to note that these consequences have been observed in cases where pain relief was administered too early, at the very beginning of labor. Take note of this, and do not rush the doctors to give you this pain relief while you are able to endure the contractions on your own.
• In the second stage of labor, in almost all cases, efforts weaken. Despite the full dilatation of the cervix, there is no pushing, and if a woman in labor has to push “without pushing,” she quickly gets tired, and this is still in to a greater extent makes childbirth difficult.

Other researchers obtained similar results.

Consequences after epidural anesthesia for the mother

These consequences do not have clear evidence, but are considered quite possible:

• Increased risk postpartum hemorrhage
• Dysfunction Bladder(urinary incontinence). It also happens after spontaneous childbirth.
• Chronic headache
• Long-lasting pain in the back and lower back after childbirth
• Numbness and tingling in various parts of the body, periodic ringing in the ears, sensory disturbances.

Epidural anesthesia: consequences for the child

The effect of this type of anesthesia on the fetus has been studied very little so far. However, it must be recognized that neither hypotension in the mother nor the resorptive effect of drugs can affect the child.

• Studies have confirmed lower Apgar scores in these newborns and their overall poorer health. They were more susceptible to infections, and neonatal hyperbilirubinemia was more common.
• In the first days after birth, such newborns are lethargic, with a decrease in motor activity can persist in a child for up to 5 days.
• There is only one study that compared the neuropsychological development of children after normal childbirth and childbirth with epidural anesthesia - there are no consequences in this regard for babies. All children develop normally, and this, of course, is good news for you. However, immediately after birth, the child is different from the rest. He has little interest in finding the breast and does not want to suckle; he cries more. All this leads to early cessation of breastfeeding. And after such anesthesia, mothers are more likely to experience a lack of milk.

Krehbiel and Poendron studied epidural anesthesia in sheep in the 1980s. The ewes that gave birth, after being anesthetized, did not react at all to their lambs. The maternal instinct in humans is much more complex than in any animal, but some women in labor admit that at first they feel coldness towards the newborn. Perhaps it is for this reason that breastfeeding stops early, and children are easily placed under the care of nannies... We have collected

Childbirth is a painful process, so many women, especially first-time mothers, seriously think about the possibility of giving birth under anesthesia. Very popular among all methods drug pain relief During childbirth, epidural anesthesia is used. Experts say that this is the most gentle and safe anesthesia for both the mother and the child. However, despite the numerous advantages of epidural anesthesia, not every expectant mother medical indicators it may be offered.

Epidural anesthesia is a method of local anesthesia in which an anesthetic is injected using a special catheter into the epidural (epidural) space between the 3rd and 4th vertebrae of the lumbar spine, where the spinal nerves responsible for transmitting pain impulses to the brain pass. The injected medications block these impulses, so that the woman does not experience any pain during contractions, and is at the same time conscious. It is important here not to confuse concepts such as epidural anesthesia and spinal anesthesia. In the first case, in addition to pain relief, it completely immobilizes Bottom part the woman’s body, and in the second, the ability to move is preserved, the woman in labor feels contractions of the uterus, but they pass painlessly for her.

Mechanism of epidural pain relief

Epidural and spinal anesthesia are performed using the same technique, only for spinal anesthesia a thinner needle is used, and the anesthetic itself is injected directly into the cerebrospinal fluid.

The algorithm of actions of the doctor and the pregnant woman will be as follows:

1. The woman in labor must take one of the necessary positions that will provide the doctor with maximum access to the spine: either sit down with her back bent, or lie on her side, curled up.
2. A woman needs to strictly follow the doctor's instructions. The main thing is not to move for the period of time that he names. Any unnecessary body movement can lead to unpleasant consequences and complications during childbirth.
3. Before the doctor gives the injection, he will treat the puncture area with a special antiseptic. The woman will be warned that during the injection she may feel unpleasant pain, because the needle included in the epidural anesthesia kit differs in thickness from a regular needle. In some cases, but extremely rarely, the anesthesiologist may suggest that the woman in labor be given an anesthetic injection to relieve sensitivity of the skin in the place where the puncture will be made to administer anesthesia.
4. The needle will be inserted into the epidural space of the spine until it touches meninges. Then a catheter will be passed through the needle, through which painkillers will be administered: lidocaine, bupivacaine or novocaine are drugs that cannot penetrate the placenta and, accordingly, will not harm the fetus. At the time of the puncture, the woman in labor may feel a shooting sensation in her leg or back, which is normal and an indication that the catheter tube has reached the nerve root.
5. The needle is removed and the catheter tube is secured to the woman's back using an adhesive tape; it will remain there as long as the effect lasts. medications, perhaps until the end of childbirth.
6. First, the anesthesiologist will administer a test dose of the drug. If 20 minutes after this the woman no longer feels pain, and there is no numbness of the tongue, dizziness or nausea, it means that the body adequately perceives anesthesia. Normally, the entire process - puncture and installation of the catheter - takes no more than 10-15 minutes.
7. The doctor will then administer a pain reliever in one of the following directions: possible modes: either every 20 minutes in small doses, or every two hours. All this time, the woman in labor should lie quietly, because epidural anesthesia dilates the blood vessels in the legs, and if the woman stands up or makes another sudden movement, she may lose consciousness.

Medical indications for epidural anesthesia

In perinatal centers in developed Western countries, epidural anesthesia is prescribed to absolutely all women in labor who have no obvious contraindications to it in order to facilitate the birth process. And almost all women agree to this in order to avoid excruciating pain during labor. That is, while still pregnant, women plan with their attending physicians the method of delivery. Is epidural anesthesia performed in our country? Yes, but most doctors are still more inclined to think that childbirth is an absolutely normal physiological process, which, if it proceeds without complications, can pass without such medical intervention as pain relief. And epidural anesthesia is offered only to those women in labor who have certain medical conditions.

These include:

• Premature birth. This type of anesthesia stimulates the woman's pelvic floor muscles to relax so that the baby can pass through. birth canal with less resistance.

• Weak or abnormal contractions that cause the woman very severe pain, but do not give the desired effect - the cervix does not open.

• High blood pressure - an “epidural,” as pregnant women say, can normalize blood pressure.

• Heart failure, birth defects blood vessels, somatic diseases such as diabetes mellitus or bronchial asthma.

• Multiple pregnancy or one large fetus.

• A pregnant woman has some kind of pathology - malpresentation of the fetus, strong entanglement. In this case, the woman is given an epidural anesthesia for a caesarean section.

• Panic fear of childbirth, psychological unpreparedness of a woman.

As a rule, the introduction of epidural anesthesia is carried out either immediately - on initial stage contractions, or already in the process, when the doctor is finally convinced that the contractions are not false, and the woman is in labor.

For which women in labor is epidural anesthesia contraindicated?

Even when a woman requires a spinal or epidural anesthesia during childbirth, the doctor has the right to refuse this if he has the right to do so. the following medical reasons:

• A woman in labor has unstable blood pressure - it rises and then drops sharply.
• There are any deformities in the spine.
• There is an inflammatory process in the area where the puncture is to occur.
• Poor blood clotting.
• Heat.
• Obstetric hemorrhage began.
• There is an intolerance to certain drugs included in epidural anesthesia.
• The woman in labor has psychoneurological diseases, or she was admitted to the maternity hospital unconscious.

Complications and consequences of epidural anesthesia during childbirth

If the technique of performing epidural anesthesia is done professionally, then, as a rule, no complications can arise. However, it is wrong to completely exclude them. A woman who decides to resort to this type of pain relief during childbirth must be aware and clearly understand what the consequences of epidural anesthesia may be for her and her child.

What problems might a woman have?

It is absolutely normal if a woman in labor after epidural anesthesia has pain in the lower part of the spine, in the place where the anesthesia was administered. Only in the case when a woman’s back bothers her for more than three days after epidural anesthesia, it is necessary to inform the doctor about this in order to avoid sad consequences. What other complaints, besides back pain after epidural anesthesia, may arise:

1. Some women in labor experience headaches after an epidural. They usually last for three weeks after birth. This can happen if the puncture damages the dura mater and allows cerebrospinal fluid to leak into the epidural space.
2. In the place where the puncture was made, inflammation began or a hematoma formed. This problem can only arise if the anesthesiologist violated the rules of sterility during the procedure.
3. After epidural anesthesia, an allergy appeared in the form of a rash or swelling, because a woman in labor may not be aware of her susceptibility to some components of anesthesia.
4. It became difficult to breathe due to the fact that the anesthetic affected the nerves going to the intercostal muscles.
5. There were problems with urination due to hypotonicity of the bladder muscles.
6. Muscle tremors appeared.
7. There was no pain relief. According to statistics, this happens in 5% of cases.
8. The most severe complication of epidural anesthesia is paralysis, but, fortunately, such cases are extremely rare and occur either due to the inexperience of the anesthesiologist, the excessive obesity of the woman in labor, or the presence of some abnormalities of the spinal column.

What problems might a child have?

Doctors do not undertake to completely rule out the possibility of anesthetics affecting the fetus, because after all, before it is separated from the mother, the child is influenced by what happens to her body. If epidural anesthesia drugs penetrate the placental barrier with the mother’s blood flow into the baby’s blood, then the following complications may occur:

1. The pulse rate will decrease and the heart rhythm will worsen.
2. Breathing problems will occur, which may become chronic.
3. The child is diagnosed with encephalopathy.
4. The baby will be prescribed a course of antibiotics from the first days of life due to a very high temperature.

Advantages and disadvantages of epidural anesthesia during childbirth

It is one of the most common and popular types of regional anesthesia (covers a limited area of ​​the body) used in medical practice. The term "epidural anesthesia" is made up of the word "anesthesia", which means loss of sensation, and "epidural" characterizes into which space the anesthetic (the drug used to relieve pain) is injected. It is performed at different levels of the spinal cord, depending on the type of operation (obstetrics and gynecology, thoracic or abdominal surgery, urology) and which part of the body needs to be anesthetized. In obstetrics, epidural anesthesia is used at the level of the lumbar spinal cord.

In 1901, for the first time, epidural anesthesia was performed in the sacral region, with the introduction of the drug Cocaine. And only in 1921, it was possible to perform epidural anesthesia in the lumbar region. Since then, this type of regional anesthesia has been used in urology, thoracic and abdominal surgery. After 1980, epidural anesthesia was in demand and popular, it began to be widely used during childbirth, thus, a new medical field, “Obstetric Anesthesiology,” was born.

Epidural anesthesia is widely used in obstetrics: as anesthesia during caesarean section, or pain relief during natural birth. Until recently, caesarean sections were performed under general anesthesia. Switching from general anesthesia to epidural anesthesia during caesarean section has reduced the risk possible complications during surgery: hypoxia (lack of oxygen) of the fetus, maternal hypoxia (several attempts at intubation, in case of unsuccessful intubation, in women in labor with anatomical features airways), blood loss, toxic effects of drugs on the fetus and others. The most important advantage of epidural anesthesia during a cesarean section, over general anesthesia, is the preservation of the mother’s consciousness in order to hear the first cry of her baby. But it should be remembered that not in all cases, the use of epidural anesthesia is possible.

The structure of the spinal cord, its functions

The spinal cord is covered, first by the so-called soft membrane, then by the web, and then by the dura mater. Between the arachnoid and pia mater a space is formed filled with cerebrospinal fluid, which plays the role of shock absorption. The dura mater and arachnoid form protrusions (dural couplings, radicular pockets), they are necessary to protect the nerve roots during the movement of the spine. Above the dura mater in front and the ligamentum flavum in the back, the epidural space is formed into which the anesthetic is injected during epidural anesthesia. The epidural space contains: fatty tissue, spinal nerves and vessels supplying the spinal cord.
The main functions of the spinal cord are:

• reflex function- by using reflex arcs, which pass through the spinal cord, muscle contraction occurs, they, in turn, participate in the movement of the body, and also participate in the regulation of the work of certain internal organs;
• conductor function- transmits nerve impulses from the receptor (special cell or nerve ending) into the central nervous system (brain), where they are processed and the signal back again passes through the spinal cord to the organs or muscles.

Mechanism of action of epidural anesthesia

• in the form of long-term anesthesia: repeated injection of small doses of anesthetic into the epidural space, through a catheter, this type of anesthesia is used during natural childbirth or for postoperative pain relief;
• or a single injection of anesthetic into large doses, without the use of a catheter. This type of anesthesia is used for caesarean section.

Stages of epidural anesthesia

1. Preparing the patient (mother in labor): psychological preparation, warn that on the day of surgery, the patient does not eat or drink anything (if elective surgery), give her a sedative to drink, find out what drugs she is allergic to;
2. Examine the patient:

• measuring body temperature, blood pressure, pulse;
• do a general blood test (red blood cells, hemoglobin, leukocytes, platelets), blood group and Rh factor, coagulogram (fibrinogen, prothrombin);

1. Carrying out epidural anesthesia:

• Preparing the patient: puncture of a peripheral vein with insertion of a catheter, connect to the infusion system, install a cuff for measuring pressure, a pulse oximeter, an oxygen mask;

• Preparation of the necessary instruments: swabs with alcohol, anesthetic (lidocaine is often used), saline, a special needle with a guide for puncture, a syringe (5 ml), a catheter (if necessary), an adhesive plaster;
• correct position of the patient: sitting or lying on the side with a maximum tilt of the head);

• Definition the required level the spinal column, where it will be, epidural anesthesia is performed;
• Treatment (disinfection) of the skin area at the level of which epidural anesthesia will be performed;
• Puncture of the epidural space with the administration of the drug Lidocaine;

1. Monitoring of hemodynamics (pressure, pulse) and respiratory system.

Indications for the use of epidural anesthesia in obstetrics

• Caesarean section (planned: in case of multiple pregnancy, other history of cesarean section; or emergency: sudden deterioration in the condition of the mother or fetus, premature birth);
• High pain threshold during childbirth;
• Pregnancy accompanied chronic hypoxia(lack of oxygen) fetus;
• Sudden change in fetal heartbeat;
• Severe somatic diseases in a woman in labor (diabetes mellitus, hypertonic disease, bronchial asthma, and others);
• Malposition;
• Anomaly of labor.

Contraindications for epidural anesthesia

• Purulent or inflammatory diseases areas where it is necessary to puncture for epidural anesthesia (can lead to the spread of infection during puncture);
• Infectious diseases(acute or exacerbation of chronic);
• Lack of necessary instruments (for example: a device for artificial ventilation of the lungs) with the development of possible complications;
• Changes in tests: blood clotting disorder or low platelets(may lead to heavy bleeding), high white blood cells and others;
• If the woman in labor refuses this manipulation;
• Anomalies or pathology of the spine (osteochondrosis with severe pain, herniated disc);
• Low blood pressure (if 100/60 mmHg or lower), as epidural anesthesia lowers the blood pressure even further;

Benefits of epidural anesthesia during childbirth (caesarean section)

• The woman in labor is conscious in order to receive pleasure at the first cry of her baby;
• Provides relative cardio stability vascular system, in contrast to general anesthesia, in which during the induction of anesthesia or at a low dose of anesthetic, the pressure and pulse increase;
• Can be used in some cases when full stomach, general anesthesia is not used with a full stomach, as there may be reflux of gastric contents into respiratory system;
• Does not irritate the respiratory tract (in general, they are irritated by the endotracheal tube);
• The drugs used do not have a toxic effect on the fetus, since the anesthetic does not enter the blood;
• Does not develop hypoxia (lack of oxygen) of the woman in labor, including the fetus, unlike general anesthesia, during which hypoxia can develop as a result of repeated intubation, incorrect adjustment of the machine for artificial ventilation of the lungs;
• Long-term anesthesia: first, epidural anesthesia can be used to relieve pain during childbirth, in case of complicated labor, with an increase in the dose of anesthetic, a caesarean section can be performed;
• In surgery, epidural anesthesia is used against postoperative pain(by injecting an anesthetic into the epidural space through a catheter).

Disadvantages of epidural anesthesia during childbirth

• Possible erroneous administration of the drug (in a large dose) into a vessel has toxic effect on the brain, which can subsequently lead to sharp decline blood pressure, development of seizures, respiratory depression;
• Erroneous injection of an anesthetic into the subarachnoid space, in small doses does not matter, in large doses (long-term epidural anesthesia with the introduction of a catheter), cardiac and respiratory arrest may develop;
• To perform epidural anesthesia, high medical training of a specialist (anesthesiologist) is required;
• Long interval between the administration of the anesthetic and the start of the operation (approximately 10-20 minutes);
• In 15-17% of cases, there is insufficient (not complete) anesthesia, which results in discomfort for the patient and the surgeon during surgery, so additional administration of drugs into a peripheral vein is necessary;
• Possible development neurological complications resulting from trauma to the spinal root with a needle or catheter.

Consequences and complications of epidural anesthesia

• The feeling of pins and needles, tingling, numbness and heaviness in the legs, which develops after the introduction of an anesthetic into the epidural space, is the result of the action of the anesthetic drug on the spinal roots. This feeling disappears after the drug wears off;
• Trembling often develops a few minutes after the anesthetic is injected into the epidural space; this is a normal, harmless reaction that goes away on its own;
• Reduction (relief) of pain when using epidural anesthesia during physiological labor;
• Inflammatory processes at the injection site, with antiseptics (sterility), in such cases it is possible local application ointments or solutions (antibiotics);
• An allergic reaction to a drug requires stopping the administration of the drug that caused the allergy and introducing antiallergic drugs (Suprastin, Dexamethasone and others);
• Nausea or vomiting develops as a result of a sharp drop in blood pressure. When the doctor corrects the pressure, these symptoms disappear;
• A drop in blood pressure and pulse in a woman in labor, therefore, when performing epidural anesthesia, solutions for infusion or cardiotonics (Epinephrine, Mezaton or others) must be prepared;
• Post-puncture headache develops as a result of an erroneous puncture of the dura mater, so it is recommended to take a horizontal position for a day, and only on the second day can you get out of bed. This is explained by the fact that in horizontal position, pressure increases in the spinal cord canal, which leads to leakage cerebrospinal fluid, through the punctured channel, and this in turn leads to the development of headaches. It is also necessary to use anesthetics to reduce pain (Analgin or other drugs).
• Acute systemic intoxication develops as a result of erroneous injection of an anesthetic (in large doses) into a vessel, so the doctor, when administering an anesthetic, must be sure that the needle is in the epidural space (check using aspiration, using a test dose);
• Pain in the back, due to trauma to the spinal root, or at the puncture site.

What happens after an epidural?

Depending on the dose of anesthetic administered, the doctor may prohibit you from getting out of bed and moving around for some time after the operation. If there are no other contraindications associated with the operation, it is usually allowed to stand up as soon as the patient feels that sensation and movement in the legs have been restored.

If epidural anesthesia is continued for a long time, bladder catheterization may be required. Due to the disconnection of innervation, independent urination becomes difficult. When the anesthetic wears off, the doctor removes the catheter.

How much does epidural anesthesia cost?

What is the difference between spinal and epidural anesthesia and epidural anesthesia?

Spinal or spinal anesthesia is a procedure during which an anesthetic is injected into the subarachnoid space, located, as its name suggests, under the arachnoid membrane of the spinal cord. The indications for it are almost the same as for epidural anesthesia: cesarean section, operations on the pelvic and abdominal organs below the navel, urological and gynecological operations, operations on the perineum and lower extremities.

Sometimes a combination of spinal and epidural anesthesia is used. This combination allows:

• reduce the dose of anesthetics administered into the epidural and subarachnoid space;
• enhance the advantages of spinal and epidural anesthesia and eliminate the disadvantages;
• enhance pain relief during and after surgery.

Can an epidural affect a baby?

• dose of anesthetic;
• duration of labor;
• characteristics of the child’s body.

It is known that epidural anesthesia can lead to problems with breastfeeding. Other negative consequence This is due to the fact that during natural childbirth under epidural anesthesia the child becomes lethargic, which makes it difficult for him to be born.

What is caudal anesthesia?

The first epidural anesthesia in history was caudal.

Indications for caudal anesthesia:

• operations in the perineal area, rectum and anus;
• anesthesia in obstetrics;
• plastic surgery in gynecology;
• Pediatric epidurals: Caudal anesthesia is best for children;
• sciatica- lumbosacral radiculitis;
• surgical interventions on the abdominal and pelvic organs located below the navel.

Advantages and disadvantages of caudal anesthesia:

Is epidural anesthesia used in children?

• If the child remains conscious during the operation, then he experiences fear. It is often impossible, like an adult, to persuade him to lie still. Therefore, epidural anesthesia in children is often performed in combination with light anesthesia.
• Doses of anesthetics for children differ from doses for adults. They are calculated using special formulas, depending on age and body weight.
• In children under 2-3 years old and weighing less than 10 kg, caudal anesthesia is used.
• In children, the lower end of the spinal cord is located in relation to spinal column lower than that of an adult. The fabrics are more delicate and soft. Therefore, epidural anesthesia must be performed with extreme caution.
• In children younger age The sacrum, unlike adults, is not yet a single bone. It consists of individual unfused vertebrae. Therefore, in children, an epidural needle can be passed between the sacral vertebrae.

For what other operations can epidural anesthesia be used?

Epidural anesthesia may be used:

• In combination with general anesthesia. This allows you to reduce the dose of narcotic painkillers that the patient will need in the future.
• As the only independent method pain relief, as during a caesarean section.
• As a means to combat pain, including post-operative pain.

• Organ surgeries abdominal cavity, especially those located below the navel:
  • appendectomy(surgery for acute appendicitis);
  • operations in gynecology, for example, hysterectomy- uterus removal ;
  • hernia repair for hernias of the anterior abdominal wall;
  • bladder surgery;
  • operations on prostate gland;
  • direct and sigmoid colon;
  • sometimes they even perform it under epidural anesthesia hemicolectomy- removal of part of the colon.
• Operations on the organs of the upper abdominal cavity (for example, on the stomach). IN in this case Epidural anesthesia can only be used in combination with general anesthesia, as discomfort or hiccups may occur due to the fact that it is not blocked diaphragmatic, wandering nerve.
• Operations in the perineal area (the space between the anus and the external genitalia). Epidural anesthesia is especially often used during surgery on the rectum. It helps to relax the anal muscle sphincter and reduce blood loss.
• Urological operations, including on the kidneys. Epidural anesthesia is primarily used in older people for whom general anesthesia is contraindicated. But when operating on the kidneys under this type of anesthesia, the surgeon must be careful: there is a risk of opening pleural cavity, which contains the lungs.
• Operations in vascular surgery, for example, for aortic aneurysm.
• Operations on blood vessels, joints, leg bones. For example, hip replacement can be performed under epidural anesthesia.

• Pain relief in the postoperative period. Most often it is performed when the operation was performed under epidural anesthesia or in its combination with general anesthesia. By leaving the catheter in the epidural space, the doctor can provide pain relief for several days.
• Pain after severe injury.
• Back pain (ischiolumbalgia, lumbodynia).
• Some chronic pain . For example, phantom pain after removal of a limb, joint pain.
• Pain in cancer patients. In this case, epidural anesthesia is used as a method palliative(alleviating the condition, but not leading to a cure) therapy.

Is epidural anesthesia performed for a herniated disc?

• radiculitis;
• protrusion intervertebral disc or formed intervertebral hernia;
• narrowing of the spinal canal.

Epidural administration of steroids (drugs of adrenal hormones, - glucocorticoids, - which have a pronounced anti-inflammatory and analgesic effect) in conditions such as radiculopathy, radicular syndromes, intervertebral hernia, osteochondrosis, spinal stenosis.

Often the anesthetic and glucocorticosteroids.

Is epidural anesthesia included in the birth certificate?

If epidural anesthesia is performed according to indications, it is included in the birth certificate. In this case this type medical care is provided free of charge.

But epidural anesthesia can also be performed at the request of the woman herself. In this case it is additional paid service which will have to be paid in full.

Is epidural anesthesia used during laparoscopy?

• Higher risk of oxygen deprivation due to increased levels of carbon dioxide in the blood.
• Irritation phrenic nerve, whose functions are not disabled during epidural anesthesia.
• The possibility of aspiration is the entry of saliva, mucus and stomach contents into the respiratory tract as a result of increased pressure in the abdominal cavity.
• With epidural anesthesia, it is often necessary to prescribe strong sedatives, which can suppress breathing - this further increases oxygen starvation.
• Higher risk of cardiovascular system dysfunction.

What drugs are used for epidural anesthesia?

Drug name	Description
Novocaine	Currently, it is practically not used for epidural anesthesia. It begins to act slowly, the effect does not last long.
Trimekain	It acts quickly (numbness begins after 10-15 minutes), but not for long (the effect stops after 45-60 minutes). Most often used for epidural anesthesia through a catheter or in combination with other anesthetics.
Chloroprocaine	Just like trimecaine, it acts quickly (numbness begins after 10-15 minutes), but not for long (the effect stops after 45-60 minutes). It is used for short-term and outpatient interventions, as well as for epidural anesthesia through a catheter (in this case it is administered every 40 minutes).
Lidocaine	It begins to act quickly (10-15 minutes after administration), but the effect lasts quite a long time (1-1.5 hours). Can be administered through a needle or through a catheter (every 1.25-1.5 hours).
Mepivacaine	Just like lidocaine, it begins to act in 10-15 minutes and ends in 1-1.5 hours. It can be given through a needle or through a catheter, but this drug is not recommended for long-term pain relief during labor because it enters the bloodstream of the mother and baby.
Prilocaine	The speed and duration of action are the same as lidocaine and mepivacaine. This drug is not used for long-term pain relief and in obstetrics, as it negatively affects the hemoglobin of the mother and fetus.
Dicaine	It begins to act slowly - 20-30 minutes after administration, but the effect lasts up to three hours. This is enough for many operations. But it is important not to exceed the dose of the anesthetic, as otherwise its toxic effects may occur.
Etidocaine	It begins to act quickly - after 10-15 minutes. The effect can last up to 6 hours. This drug is not used in obstetrics, as it causes severe muscle relaxation.
Bupivacaine	It begins to act in 15-20 minutes, the effect lasts up to 5 hours. In low doses, it is often used to relieve pain during labor. This anesthetic is convenient because it acts for a long time and does not lead to muscle relaxation, so it does not interfere with labor. But with an overdose or injection into a vessel, persistent toxic effects develop.

What medications can affect epidural anesthesia?

The issue of labor pain relief is becoming high on the agenda for many women in late pregnancy. And most often it is medicinal methods of pain relief that are considered, the most famous of which is epidural anesthesia.

Everyone’s pain threshold is different, and in principle, during labor, a woman in labor experiences far from the most pleasant sensations, but on the topic of whether it is worth interfering with the natural birth process, and there is ongoing debate to this day. And if in the USA and Western Europe Most women choose an epidural; in Russia this has not yet become commonplace. After all, not everything is so simple: an injection, loss of pain, easy birth, healthy baby and a happy mother. Epidural anesthesia, like any other medical intervention, has a number of consequences for the health of the mother and newborn.

Epidural anesthesia: possible complications for a woman in labor

Complications directly during childbirth

1. Consequences of incorrect administration of anesthetic :

• loss of consciousness and cardiac dysfunction as a result of exposure to narcotic substance into the circulatory system;
• acute intoxication of the body;
• segmental anesthesia, when pain is not relieved in all areas (for example, it disappears in the left half of the body, but remains in the right);
• septic meningitis as a result of infection during puncture and prolonged stay of the catheter in the epidural space;
• damage to the spinal roots with a needle or catheter, bleeding in the epidural space, paralysis of the lower extremities.

1. Insufficient effect of anesthesia , persistence of pain. This usually involves increasing the amount of the administered drug.
2. A woman in labor has a decrease in blood pressure and a drop in heart rate . In this case, saline solution or cardiotonic agents are administered intravenously to enhance contractions of the heart muscle. Medicines are administered while the woman is lying down, and this position can slow down the birth process (gravity does not help the baby move).
3. Nausea and vomiting . The reasons are a decrease in pressure, disruption of work nervous system, brain hypoxia, side effect narcotic drugs.
4. Allergic reaction on the administered drug. Requires discontinuation of its use and administration of antiallergic drugs.
5. Weakness, dizziness, feeling of shortness of breath caused by the effect of drugs on the respiratory system. Additional oxygen supply through a mask is required.
6. Itchy skin in the face, neck and chest area. Is side effect effects of narcotic drugs, disappears after they are removed from the body by the liver and kidneys.
7. Paresthesia– a sensation of “lumbago” when installing a catheter. Occurs in some cases, for example, with severe curvature of the spinal column of a woman in labor.
8. Hyperthermia as a result of disruption of the nervous system. An increase in temperature to 38 degrees is a symptom that is difficult to distinguish from the consequences of infection, and therefore the likelihood of using antibiotics in the postpartum period increases.
9. Hydrotrauma of the spinal cord associated with the administration of an anesthetic under pressure. The appearance of a hematoma as a result of damage to the vessels of the epidural space.
10. Complications of the birth process . In some cases, labor may slow down. The use of epidural anesthesia often results in the woman not feeling any effort. In this regard, the risk of using forceps, vacuum extraction, and, as a consequence, possible injury during childbirth increases.
11. Increases the likelihood of a caesarean section . This is, rather, the version expressed by a number of doctors. The essence of their opinion is this: when using epidural anesthesia, the duration of labor may increase; The pelvic floor muscles relax and the fetus changes its position. These factors are likely to lead to operative delivery. However, there is no documentary evidence for this version.

Complications that occur after childbirth

1. Numbness, tingling (“pins and needles”), feeling of heaviness, tremors in the legs after childbirth. The unpleasant sensations disappear when the effect of the drugs on the body ends.
2. Urinary dysfunction after childbirth. Numbness of the body “confuses” a woman and prevents her from feeling the urge to urinate.
3. Postpartum cerebrospinal fluid leak as a result of an erroneous puncture of the dura mater, as well as associated headaches and tinnitus.
4. Pain at the puncture site .
5. Inflammatory process at the site of the epidural injection.

Long-term effects of epidural anesthesia

1. Prolonged headaches . The cause is an accidental puncture of the dura mater during epidural anesthesia. Occurs in 3% of cases, resulting in 70% of women suffering from headaches for many months after childbirth.
2. Long-term back pain caused by for various reasons. It can last for months or even years.
3. Emergence inflammatory process and spinal cord cysts .

Epidural anesthesia: consequences for the child

1. Deterioration of uteroplacental blood flow , and as a result, a decrease in the child’s heart rate. Can be interpreted as an indication for caesarean section.
2. Breathing disorders in a newborn , which leads to the use of mechanical ventilation and intubation (insertion of a special tube into the baby’s throat to establish normal breathing).
3. Confusion, motor impairment, difficulty sucking . The risk of a child receiving a diagnosis of encephalopathy increases 5 times.
4. Increased likelihood of newborns receiving antibiotics (if the mother had a fever).
5. Violation of the primary mother-child connection . Our body is designed in such a way that when pain occurs, it releases endorphins to compensate for it. Part of this hormone goes to the child, for whom childbirth is also a difficult test, and he is not yet able to produce endorphins himself. Thus, the baby is left without mother's support. In addition, blocking pain turns the birth process into “extracting” the baby. Getting rid of discomfort Without experiencing childbirth to the fullest, it is unlikely that a mother will experience such complete delight at the birth of a child. The maternal instinct is triggered precisely as a result of complex hormonal changes in a woman’s body, including those occurring during childbirth.

In some situations (in particular, when performing a cesarean section), the choice of whether to use anesthesia is not even worth it. And in natural childbirth, the main indication for its use is discoordination of labor. Therefore, you should not think about the fact that you will need anesthesia. Childbirth is a very unpredictable process, but at the same time provided for by nature itself. Application of any medicinal methods pain relief is associated with a number of serious risks, which are worth remembering and not trying to get a “magic injection” at any cost.

Probably, all first-time expectant mothers, without exception, are frightened by the upcoming birth. A significant portion of the horror stories that friends share and online forums are full of are stories about how painful contractions and childbirth itself are.

Of course, it is unlikely that the sensations that a woman experiences during labor can be called pleasant, but they are the ones that help to truly understand and realize the birth of a new life. However, today it is possible to bypass natural mechanisms and significantly simplify the life of a woman in labor by using epidural anesthesia during childbirth.

In the lumbar region of the spine, in the epidural space (inside the spinal canal, between its outer wall and the hard shell of the spinal cord), the spinal roots emerge. It is through them that the transmission occurs nerve impulses from the pelvic organs, including the uterus.

The administered painkillers block the transmission of pain impulses to the brain, thereby allowing the laboring woman not to feel contractions. However, the dose is calculated so that the woman in labor does not feel anything below the waist, but can move independently. Epidural anesthesia during childbirth allows the woman to remain fully conscious.

It is worth noting that the effect of epidural anesthesia, unless there are special indications, applies only to contractions during the dilatation of the cervix. The woman goes through the period of pushing and the birth itself without pain relief.

Epidural and spinal anesthesia: what is the difference?

Sometimes these two types of anesthesia are confused, which is not surprising, since they are very similar in appearance. Difference spinal anesthesia in that a sharper needle is used, and the anesthetic is injected into the cerebrospinal fluid below the level of the spinal cord, therefore, the mechanism of action of the drugs is somewhat different than with epidural anesthesia. In addition, the latter is considered safer in terms of complications.

Price

If anesthesia is carried out according to medical indications, then they do it for free. In the case when a woman herself decides to give birth with epidural anesthesia, the price of this manipulation will be about 3,000-5,000 rubles, depending on the maternity hospital.

How do they do it?

1. To carry out a puncture, a woman needs to sit down with her back bent, or lie on her side and curl up. In other words, ensure maximum access to the spine. Moreover, you need to try very hard not to move at all - freeze in the position determined by the anesthesiologist and be prepared for the fact that you will feel some short-term unpleasant sensations (at this moment it is important not to move away from the doctor). The more still you are, the lower the risk of complications after epidural anesthesia.

2. The puncture area is carefully treated with an antiseptic solution.

3. A regular injection of an anesthetic is given in order to relieve the sensitivity of the skin and subcutaneous fat at the site of the upcoming puncture.

4. The anesthesiologist makes a puncture and inserts a needle into the epidural space of the spine until it reaches the dura mater.

If you feel that a contraction is about to begin during the manipulation, be sure to inform the anesthesiologist about this, he will stop. Remember: your main task is not to move!

Also tell your anesthesiologist if you feel any changes in your condition. This may be: a feeling of numbness in the legs or tongue, dizziness, nausea, etc. Normally, nothing like this should happen, and if something goes wrong, you need to immediately inform your doctor about it, since it is easiest to correct the situation at this stage.

5. A thin silicone tube is passed through the needle - a catheter - through which painkillers enter the epidural space. The catheter remains in the back as long as the analgesic effect is needed. With it, a woman can move freely, however sudden movements should be avoided. During the birth itself, the catheter will also be in the back of the woman in labor.

As the catheter is inserted, you may feel a shooting sensation in your leg or back. This is normal - it means the tube has touched a nerve root.

6. The needle is removed and the catheter tube is secured to the back using adhesive tape.

7. A test injection of a small amount of anesthesia is carried out to check for inadequate body reactions.

8. After childbirth, the catheter is removed from the happy mother’s back, the puncture site is sealed with an adhesive plaster and the woman is recommended to remain in a lying position for some time, this is necessary to minimize the risk of possible complications after epidural anesthesia.

Puncture and installation of the catheter takes about 10 minutes. The drugs usually begin to work within 20 minutes after administration. Many women are frightened by the possibility of spinal manipulation; as a rule, everyone wonders whether epidural anesthesia is painful. We hasten to reassure you, the woman in labor will feel quite tolerable discomfort that will last only a few seconds. Subsequently, even with movement, the catheter is not felt.

The administration of painkillers is possible in two modes:

• continuously, at short intervals - in small doses;
• once, repeating if necessary after 2 hours - while the drugs are working, the woman is recommended to lie down, since the vessels of the legs dilate, and the outflow of blood to them can lead to loss of consciousness if the woman in labor gets up.

What drugs are used for epidural anesthesia?

Drugs that are not able to cross the placenta are usually used: Lidocaine, Bupivacaine, Novocaine.

Does epidural anesthesia affect the baby's health and labor?

Currently, most experts believe that epidural anesthesia used during childbirth has no effect on the baby. Injected anesthetics do not penetrate the placenta and are not absorbed into the baby’s blood.

As for labor, opinions differ. Some practicing anesthesiologists claim that anesthesia has no effect on the course of labor, including the speed of dilatation, while others say that the speed of the first stage of labor (dilatation of the cervix) increases, but pushing becomes less pronounced. In any case, if anesthesia affects labor, then insignificantly.

Indications for use

1. Premature pregnancy. In this case, with the help of epidural anesthesia during childbirth, the mother’s pelvic muscles relax. This means that the baby will experience less resistance as it passes through the birth canal.
2. Discoordination of labor. This phenomenon occurs when contractions occur, but do not bring the desired effect: the muscles of the uterus contract incorrectly, not at the same time, and the cervix does not dilate.
3. Blood pressure is higher than normal. Anesthesia helps reduce and normalize blood pressure levels.
4. Necessity surgical intervention (multiple pregnancy, the child is too large) or the inability to perform general anesthesia.
5. Long and painful labor.

In Western clinics, epidural anesthesia during childbirth is often performed without indications, simply so that the woman giving birth experiences as little discomfort as possible. However, the opinions of experts on this matter are diametrically opposed.

Contraindications

Like any medical intervention, epidural anesthesia during childbirth has a number of contraindications:

• pressure abnormalities: low arterial or elevated cranial;
• spinal deformity and difficult access for catheter insertion;
• inflammation in the area of ​​potential puncture;
• a bleeding disorder, low platelet count, or blood poisoning;
• possibility of obstetric hemorrhage;
• drug intolerance;
• psychoneurological diseases or unconsciousness of the woman in labor;
• some heart or vascular diseases; in this case, the possibility of epidural anesthesia is considered individually;
• refusal of the woman in labor to receive pain relief.

Consequences and complications after epidural anesthesia during childbirth

Entry of anesthetics into the venous bed. There are quite a few veins in the epidural space, which creates a threat of drugs entering the bloodstream. If this happens, the woman will feel weakness, dizziness, nausea, an unusual taste in the mouth, and numbness of the tongue. We wrote about this above and have already said that if any deviations in health occur, it is necessary to urgently inform the anesthesiologist.

Allergic reactions. If a woman has not encountered various anesthetics (painkillers) before giving birth, then during anesthesia it may become clear that she is predisposed to an allergy to a particular drug, which in turn is fraught with the development of anaphylactic shock (disruption of the functioning of vital systems and organs) . In order to prevent a severe allergy attack, a minimal amount of anesthetics is first administered.

Quite rare, but occurring, complications after epidural anesthesia include: difficulty breathing. The complication occurs as a result of the effect of anesthetics on the nerves going to the intercostal muscles.

Headache and back pain. Sometimes women complain that their back hurts after epidural anesthesia. Pain occurs as a result of the needle puncturing the dura mater and allowing some cerebrospinal fluid to enter the epidural space. Back pain after anesthesia usually develops within 24 hours, but there are cases when it lasts for months, the same can be said for headaches. This complication is usually treated by medication or by repeating the puncture and injecting a small amount of the woman’s own blood into the leak site to seal the puncture.

Drop in blood pressure level, and, as a result, “spots” in the eyes, a sudden attack of nausea or vomiting. To prevent this consequence of using epidural anesthesia during childbirth, a drip is usually placed and it is recommended to lie down for some time after the puncture and installation of the catheter.

Hypotonicity of muscles bladder and difficulty urinating.

What else is dangerous about epidural anesthesia? I would not like to scare expectant mothers who are waiting for epidural anesthesia during childbirth, but it is still necessary to mention that very rarely complications arise after anesthesia, such as paralysis lower limbs.

Failed epidural anesthesia

If you believe the statistics, then in 5% of cases of using epidural anesthesia during childbirth, pain relief does not occur at all, and in 15% it occurs partially.

Why is this happening? Firstly, it is not always possible to get into the epidural space. The reason for this may be the inexperience of the anesthesiologist (although usually young doctors perform manipulations in the presence of more experienced colleagues), excessive fullness women in labor or spinal column abnormalities.

Secondly, a woman may not feel pain on the right or left. So-called mosaic anesthesia occurs if the connecting septa in the epidural space prevent the spread of anesthetics. In this case, you need to inform the anesthesiologist, he will increase the concentration of the drugs, advise you to turn on the side where the anesthesia did not work, or make another puncture.

Epidural anesthesia: pros and cons

So, if you have neither indications nor contraindications for epidural anesthesia during childbirth, and you are considering this option in order to make an appearance long-awaited baby more comfortable, carefully weigh all the positive and negative aspects.

It should be clarified that we are not considering the advantages and disadvantages of epidural anesthesia during childbirth over other types of pain relief, but will try to analyze it relative to natural childbirth without drug intervention.

The benefits of epidural anesthesia

• the ability to relieve pain during labor and make the birth process as comfortable as possible for the mother;
• the opportunity to “take a break”, rest or even sleep if childbirth lasts a very long time;
• Reducing the risk of increased blood pressure in women suffering from hypertension.

Disadvantages of epidural anesthesia

• risk of complications varying degrees gravity
• a sharp drop in blood pressure in hypotensive women;
• loss of psycho-emotional contact with the child; This point causes a lot of controversy - often mothers who had a successful birth using epidural anesthesia treat such statements with a good dose of cynicism, but let's try to look at it from the outside.

During childbirth, not only the mother experiences enormous stress, but at least she is in familiar conditions, but the baby has to master completely new world. It’s not for nothing that the passage of a child through the birth canal is called “expulsion.” The baby is subject to extreme stress, preparing for and leaving the very safe place, abruptly plunging into a completely unfamiliar and largely hostile environment.

When both mother and baby experience pain, it binds and unites them more strongly. Probably, any mother whose child was sick would happily share his suffering, because for her it is unbearable to look at the suffering of her baby from the outside.

The same thing happens during childbirth, although we do not see the state in which the child is about to be born, this is not a reason to abandon him alone at such a difficult moment. Better prepare for childbirth, learn techniques correct breathing and relaxation, and try to help not only yourself, but also the child in a natural way.

In addition, it is known that pain provokes the release of endorphin - the hormone of happiness and pleasure. In newborns, the production of this hormone is not possible, so during childbirth they receive it from the mother. And if the mother does not feel pain, then there is no need for the hormone - the woman’s body does not produce it either for herself or for the child, who still needs it.

So, if epidural anesthesia is indicated for a woman, then there is no point in talking about the advisability of its use. If a woman literally “goes crazy” from unbearable pain(this usually happens if any obvious or implicit complications have arisen) - then pain relief is also a necessity.

However, if normal flow nothing prevents future mom should carefully weigh the pros and cons of using epidural anesthesia during childbirth.

Perhaps it is worth going through the process determined by nature in order to feel real unity with the child, fully share the miracle of birth with him, and, in the end, completely eliminate the risks associated with drug intervention in such a delicate system as the spine.

Video of how to place an epidural

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