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The epidural is the type of anesthesia used by patients of choice. A catheter is inserted for the epidural analgesia of labor. The catheter is inserted into the epidural or scleral space surrounding the dura mater of the spinal cord and extending from the foramen at the base of the skull to the sacral hiatus.
It is also performed with a contraindication to a subarachnoid block. The advantages of such anesthesia include slower blockage, less frequent headaches during and after anesthesia, the possibility of any prolongation of anesthesia and postoperative analgesia.
The disadvantage is that it is slightly more difficult to perform – the anesthesia itself, longer waiting time for analgesia, greater drug transfer through the placenta into the fetal bloodstream due to its higher concentration in the mother’s blood, the possibility of drug overdose in the event of accidental insertion of the catheter into the subarachnoid or intravascular space.
Epidural hematoma is a very rare but serious complication. A hematoma with limb paralysis occurs less than 1 in 200. anesthesia.
Bleeding into the epidural space is much more common after epidural anesthesia, usually due to medication or the patient’s condition itself. Ordinary heparin accounted for 30% of all hematomas, and it is a drug often used in obstetrics and gynecology. The pregnancy itself and the complicating conditions in the form of hypertension or thrombocytopenia, i.e. a reduction in the number of blood platelets in the serum, increase the risk of bleeding complications of the blockade used. It also happens that the drug is unintentionally administered to the subarachnoid space, which results in a high sensory blockage up to and including the central block, which results in unintentional exclusion of the high centers in the medulla. It happens 1 – 3% of the time. This situation poses a threat to the fetus with hypoxia, and for the mother, a respiratory paralysis, loss of consciousness.
Puncture of blood vessels occurs quite often, which is caused by their significant widening during pregnancy. The administration of drugs into the vessels causes a direct effect on the central nervous system and the vascular system of both the mother and the fetus. The mother may experience unconsciousness, seizures, drop in blood pressure and even cardiac arrest.
With epidural anesthesia, you can relieve labor pains associated with contractions of the uterine muscle, opening of the cervix, and finally the passage of the newborn baby through the genital tract.
Unfortunately, the abolition of the pain suffered by the woman in labor often hinders and slows down the progress of labor in the second stage, the patient cooperates less well with the delivery room staff.
So, undoubtedly, epidural anesthesia has its advantages when used correctly and at the right time, but you should bear in mind its dangers and disadvantages.
Text: lek. med. Ewa Zarudzka