What is an 'epidural'?

What is an 'epidural'?

Samuel Seelig (Anesthesiologist, Los Angeles, California) gives expert video advice on: What are the risks of an epidural?; Can I take additional pain medication while having spinal anesthesia or an epidural?; Does general anesthesia affect breastfeeding? and more...

An Epidural is a regional anaesthetic. The epidural space is just outside of the spinal canal. It is entered using a Tuohy needle which has a bevel edge. In order to do an epidural, you pass through the skin, the subcutaneous tissue, the interspinous and supraspinous ligament, and then the ligament flavum. These all have a separate consistency and you must be able to feel these in order to pop into the epidural space. Unlike a spinal, which is driven through the Dura mata with a sharper needle to get to the end point of the cerebral spinal fluid. You do not want to see cerebral spinal fluid when you do the epidural, you are in the space just outside of the spinal canal. In that space you can infuse dilute local anaesthetic solutions so that the women in labour can have analgesia, in other words, not feel her contractions but only feel some pressure during the contractions, and allow that labour to continue. The advantage is that the mother is awake, alert and enjoys her labour. She is comfortable and has some semblance of analgesia. The epidural can be activated at the time of delivery to make the paranium numb using a concentrated and more potent solution. It can also be used if a patient has a caesarean section, not unlike a spinal where you would increase the volume of medication and make the mother numb from the chest down.