What is Epidural Anesthesia?

Epidural anesthesia involves inserting a tiny plastic tube into the epidural space. The spinal nerves (which carry the sensations from your body) pass through the epidural space. Medicine is injected through this tiny plastic tube (or epidural catheter) into the epidural space. This medicine blocks the messages of sensation that tell the brain what your body is feeling. The epidural catheter is usually placed in the lower back for procedures below the umbilicus (belly button). The catheter may be placed higher in the back for procedures of the chest or upper abdomen. For example, for knee or hip surgery, the epidural catheter is placed in the lower back. This allows the medicine to anesthetize or block the feelings in the lower half of your body. After surgery, the medicine can be changed to control your pain or discomfort after surgery. This anesthesia is similar to a Spinal Anesthetic. The Spinal Anesthetic is a single shot of medication which may last from 1 to 4 hours. The epidural catheter, however, allows repeated injections of the medication. This may permit many hours of anesthesia. In addition, the epidural catheter may be used after surgery for pain control.

How is the catheter put in the epidural space?
For epidural anesthesia, the placement of the epidural catheter is done with the patient in either the holding room (the room where patients are prepared for surgery) or in the operating room. Prior to placement of the epidural catheter, an intravenous line will be started and you may be given sedation. At the appropriate time, the anesthesia provider will begin the procedure to insert the epidural catheter. You will be asked to sit up. The anesthesia provider will wash off your lower back with an antiseptic solution and then place a paper drape over the area. After numbing the skin with a local anesthetic, he will insert a needle into the epidural space. The patient may feel a slight burning sensation with the local anesthetic, but should rarely feel more than a pressure sensation with the epidural needle. The catheter is inserted through the needle and the needle is removed. The catheter is then taped to the patient's back. You should be able to lie on back with no discomfort. You should not feel the catheter except for the tape on your back. You may feel a cold sensation down your back as the medicine is injected through the catheter.

What comes next?
At the appropriate time, the anesthesia provider will inject medicine into the catheter. In 5 to 15 minutes you will feel a warm sensation in your legs and gradually lose feeling in the lower half of your body. You will be taken to the operating room where you will be moved to the operating table. Blood pressure, heart, and breathing monitors will be placed on you as needed. You may be given sedation to make you comfortable throughout your procedure. Many patients do not remember most of the time in the operating room because of the sedation. If at any time during the procedure you feel uncomfortable, just tell your anesthesia provider so your medicine can be adjusted. After the procedure you will be taken to the Recovery Room until you are ready to go to your room. Usually, you will be started on a medication in your epidural that will control your pain after surgery. If you are uncomfortable, please tell your nurse so your medication can be adjusted. One or two days after surgery, the epidural catheter will be removed. Removal of the catheter is a painless procedure except for the few hairs that are pulled when the tape is removed.