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Epidural is a widespread and highly effective method of anesthesia used for both natural birth and cesarean section. Over the years, both the technique and the drugs administered have significantly improved, making the epidural a very safe practice in the hands of an experienced doctor. The epidural is the most common method for painless delivery in pregnant women in most countries.
Epidural anesthesia is performed by injecting anesthetic drugs into the spine's epidural space. This causes a temporary loss of the sensation of pain in the lower half of the body. Depending on the dose of the medication administered, a transient loss of mobility of the lower limbs is also induced.
Most women describe the sensation as ranging from a slight "numbness" of the limbs to complete immobility, described as "feeling like you want to move your legs and you can't." In addition to the sensation of pain, a characteristic of epidural pain is the loss of temperature sensation, i.e., the distinction between hot and cold on the skin.
Therefore, a successful epidural anesthesia removes pain without completely removing sensation and mobility. Patients may feel pressure from uterine contractions, touches, or pulls without the sensation being painful or causing discomfort.
If the epidural is used in a cesarean section, the anesthesiologist checks its effectiveness before the surgery begins. Initially, he/she checks the temperature difference between the hand and the abdomen with a cotton swab with cold water or antiseptic.
The epidural is successful when the women can feel the cold on their hands, while in the abdomen, they describe the sensation as either a light touch or caress without feeling the temperature or no touch at all.
Similarly, the anesthesiologist uses a needle to check the patient's sensation of sharpness and pain. While it's painful on their hand, they feel a slight pressure or a complete elimination of sensation in the abdominal area.
The degree of loss of sensation of temperature and pain depends on the dose of the drug administered, which in turn depends on the purpose of administration.
Στην περίπτωση του φυσιολογικού τοκετού, όπου στόχος είναι η αναλγησία, απαιτούνται σαφώς μικρότερες δόσεις φαρμάκων. Στην καισαρική τομή, αντιθέτως, απαιτείται πλήρης αναισθησία από το επίπεδο του αφαλού και κάτω.
Η επισκληρίδιος αναισθησία γίνεται με τη γυναίκα είτε σε καθιστή είτε σε ξαπλωτή θέση στο πλάι. Η γυναίκα ενημερώνεται από τον αναισθησιολόγο και τους βοηθούς για τη στάση του σώματος που απαιτείται. Σκοπός είναι η πλάτη της γυναίκας να δημιουργεί μία καμπύλη, για να δημιουργείται χώρος μεταξύ των σπονδύλων της σπονδυλικής στήλης. Αυτό επιτυγχάνεται αφού χαλαρώσουν τελείως οι ώμοι και πέσουν προς τα κάτω. Επίσης το κεφάλι πρέπει να γέρνει ελαφρώς προς τα κάτω και το πηγούνι να έχει την κατεύθυνση προς το θώρακα.
Under aseptic conditions, the anesthesiologist administers local anesthesia, which may cause a slight burning and stinging sensation in the area for a few seconds until the anesthetic takes effect. From this point onwards, the insertion of the epidural catheter causes no pain, only a sensation of pressure either to the right and left of the spine or down the back.
If the woman feels any pain or discomfort, she must immediately inform the anesthesiologist who inserts the epidural catheter. However, it is crucial to avoid sudden movements, and the woman should remain relaxed without moving.
Μόλις δράσει το τοπικό αναισθητικό, ο αναισθησιολόγος τοποθετεί έναν πολύ λεπτό και εύκαμπτο καθετήρα, που χορηγεί τα αναισθητικά φάρμακα. Ο καθετήρας, όταν τοποθετείται, μπορεί να δημιουργήσει για μερικά δευτερόλεπτα την αίσθηση πως «γρατσουνάει» την πλάτη ή πως «περνάει ηλεκτρικό ρεύμα». Αυτή η αίσθηση γίνεται σε ορισμένες περιπτώσεις αντιληπτή από τη γυναίκα και διαρκεί μόλις μερικά κλάσματα του δευτερολέπτου.
Once the anesthesiologist inserts the catheter, the woman can easily lie on it without feeling or interfering with its action. When the drugs are administered, women describe a pleasant feeling of coolness in the back, resulting from the medicine passing through the catheter.
An effective, quick, and painless performance of epidural anesthesia requires:
The main benefit of epidural anesthesia in normal childbirth is the analgesia it provides without removing sensation. This results in women being able to push without feeling pain.
The dose and frequency of the drug are adjusted according to the woman's needs and the stage of labor, in collaboration with the obstetrician and the pregnant woman's midwife. Thanks to the analgesia from the epidural, women can rest between contractions or even sleep, especially in lengthy labor.
In addition, the analgesia lasts well into the stage immediately after the fetus's birth. Therefore, any medical procedures performed after the baby is delivered do not cause pain and discomfort to the mother.
Depending on the dosage administered, numbness of the lower limbs may be observed. As a result, the woman has reduced mobility during childbirth. However, more than a few women can stand up and walk. However, the presence of an attendant and full sensation and movement of lower limbs are mandatory.
The drugs used for epidural anesthesia can cause a drop in blood pressure or itching.
During the insertion of the catheter, it may cause the dura mater to be perforated. In that case, the woman may have headaches, nausea, and tinnitus for a few days after delivery. In addition, analgesia may be evident on only one side, resulting in limited pain relief.
These complications are immediately addressed with appropriate medication or the catheter's repositioning. Also, the anesthesiologist's experience reduces the likelihood of their occurrence to meager rates.
Η επισκληρίδιος αναισθησία δεν είναι η μοναδική μέθοδος αναλγησίας που εφαρμόζεται για να ανακουφίσει από τις ωδίνες του τοκετού. Η χρήση φαρμάκων ενδοφλεβίως ή ενδομυικά αποτελούν επίσης μία ασφαλή πρακτική που χρησιμοποιείται. Το μειονέκτημά της ωστόσο, αποτελεί η μικρότερη αποτελεσματικότητά της συγκριτικά με την επισκληρίδιο αναισθησία, λόγου του τρόπου δράσης των φαρμάκων.
Epidural anesthesia prevents the transmission of pain to the brain, making it imperceptible. In contrast, painkillers reduce the intensity of the pain that reaches the brain anyway.
It is imperative for expectant mothers to be informed in detail by medical staff about the following:
Potential complications are incredibly rare and, in most cases, transient. This makes the epidural safe, and its advantages far outweigh its complications.
The fact remains that epidural anesthesia has revolutionized how a pregnant woman experiences the birth of her child. Analgesia gives the woman greater control over her body and childbirth experience.
The decision to perform an epidural is purely personal. Each woman makes it according to her wishes, beliefs, needs, and the attending physician's recommendations. Regardless of the decision, the goal always remains the safety of the pregnant woman and the fetus.
Σημειώνεται πως για τη διενέργεια της καισαρικής τομής χρησιμοποιούνται τόσο η ραχιαία αναισθησία όσο και η γενική αναισθησία. Η ανάλυση του θέματος θα αναλυθεί σε μελλοντικό άρθρο.