Modern medicine has made fantastic leaps in keeping patients healthier and safer than ever before. Everything from over-the-counter medicine to advancements in surgical equipment and hospital technology have made treatments much more streamlined and accessible.
The epidural is another great example of medicinal achievement, becoming the go-to form of treatment for a mother during labor.
Epidurals work to provide pain relief by injecting medication into the area around the patient’s spinal nerves, and this medicine is known commonly as epidural anesthesia.
Although it’s one of the safest forms of treatment for expecting mothers, it’s not completely without risks or the potential for complications. There are some physicians who cite the effects of anesthesia on not only the delivery process but on the post-delivery of the child.
Every patient is advised to talk to their doctor before opting for epidural anesthesia. Despite it’s overwhelming safety record, there could be a prevalence of complications on an individual basis.
So what are these complications? And, how worried should you be?
Risks of an Epidural
To reiterate, the complications of an epidural are extremely rare and they shouldn’t factor into a doctor’s decision to utilize this form of anesthesia for most patients.
Even the most benign use of an epidural may cause temporary pain in the injection site, but this should go away in a few minutes.
Here are some of the more serious risks that patients should be aware of.
Epidural Blood Patch Complications
An epidural blood patch is a procedure to help manage spinal headaches which are caused by a leakage of spinal fluid.
When a headache permeates from this spinal fluid, it’s essential to stop the leak right away. An epidural blood patch injects blood into the spinal area (similar to the process for maternal situations) which shuts the opening that allows the spinal fluid leakage to occur.
It’s a relatively safe surgical procedure that provides enormous relief, but it is not without complications. Whenever blood is injected into the body within a foreign space (it doesn’t normally belong in the epidural area of the spine), this can be viewed as an irritant.
The body may fight back by giving the patient a sense of lower back or leg pain. On the bright side, the prevalence of infections are very rare since these procedures are conducted in sterile operating conditions.
That’s largely the extent of complications from an epidural blood patch.
Epidural Anesthesia Complications
Aside from blood patch complications, here are a few of the other risks posed by epidural anesthesia.
Slow Breathing
Patients may react to their epidural anesthesia in a way that induces drowsiness. This is typically caused by certain medicines. Doctors will continually monitor their patients after administering the anesthesia, but patients should disclose any medications that they shouldn’t take before the procedure begins.
Temporary Nerve Damage
On the slightly more serious side of the risk profile, temporary nerve damage can result from the epidural tube puncturing a nerve. Nerve damage can remain for a few days, but it can also last several weeks or months and it can seriously limit the person’s mobility and strength.
Incontinence
Epidurals have a tendency to relax us, so much so that a person may lose the ability to control their bladder. In more extreme cases, the person may need to use a catheter so that urine can drain more easily.
As soon as the epidural process completes, the effects of incontinence should wear off.
Nausea
Many pregnant women are familiar with nausea in general, and epidurals can be a catalyst to more nausea for some.
That feeling of sickness lasts temporarily and it’s far less common with epidural medicines over other pain-relief medicines including potent drugs like morphine.
Itchiness
A rather innocent side effect, itchiness is usually the direct result from the type of medicine used in your epidural. If the issue persists or becomes a massive inconvenience, your doctor can alter the medication used in the epidural.
How Common are Epidural Complications?
According to a study in PubMed, approximately 1.4% of epidural patients experience significant complications from the procedure. Out of more than 5,000 patients in the study, only 1 patient experienced permanent issues.
Thankfully, the most common epidural complications happen temporarily. This includes post-dural procedure headaches and minor neurologic deficits.
One of the reasons why epidurals are extremely safe is the fact that additional medications can be administered continually throughout the woman’s labor process, ensuring that the woman’s needs are met at all times.
Reducing complications is always the goal. Physicians have seen tremendous progress thanks to tools like the CompuFlo Epidural Instrument which allows them to have more control over the insertion and monitorization of epidurals.
Like the CathCeck Verification System, these tools make the procedure even more precise. They can gather insights regarding placement of the anesthesia, and they can keep a watchful eye on the mother’s internal signals as the medication is injected.
This synergy of medicine and technology is making procedures easier and more precise.
Potential Epidural Complications
The technological advancements above have stemmed the tide of complications pretty significantly, but there are a few potential difficulties some patients may face.
In addition to the risks we’ve mentioned in earlier sections, here are some of the potential complications and adverse events a patient may experience following their procedure.
Meningitis
Meningitis is a swelling that occurs of the protective membranes which cover the brain and spinal cord region, typically as a result of infection. Thanks to technology these infections are exceedingly rare and are usually the outcome of other issues (like a patient who is suffering from cancer or has sustained other injuries).
It’s a continual goal among physicians to make their operating environments as sterile as possible to decrease the likelihood of infections. Within the procedural environment itself, these physicians trust tools that allow them to inject patients with added peace of mind.
Discitis
Another slight concern of an epidural is discitis, which is an infection of the discs located between the vertebrae of the spine. Discitis is potentially serious, although it’s only seen in approximately 1 out of every 100,000 people in the United States.
Because there is a feeling of pain and discomfort from the inflammation of the discs in the spine, patients will need to seek attention as soon as possible.
Soft Tissue Abscess
A soft tissue abscess forms via a buildup of pus within the spine’s soft tissue at the site of injection. These pockets of fluid are housed in a thick wall, and require removal right away to prevent the spread of infection.
Antibiotics or antifungal treatments should be administered pronto.
Cardiovascular Complications
This ties into the side effect of low pressure which is felt by some epidural patients. Fortunately, issues involving the heart are rare during these procedures thanks to electronic monitoring equipment that can sense immediate changes in heart rate.
Excessive Bleeding
If damage is done to the arteries, there is a chance that localized bleeding will occur. The result could be a blood clot which prevents blood from reaching vital tissues.
What About Epidural Steroid Injections?
Epidural steroid injections are commonly used for patients who exhibit acute back or leg pain. While these injections will reduce nerve pain and inflammation in the short-term, these benefits can be fleeting.
There is also a risk profile that mirrors the other types of epidurals, including feelings of nausea, dizziness, fainting, or pain within the injection site.
As far as which steroid injections are least risky? Generally speaking, epidural injections given within spinal levels L4 or lower are the best. These injections carry the lowest risk for long-term epidural injections complications like spinal cord damage, stroke, or dural puncture.
There are multiple types of steroids used in epidural injections. Particulate steroids are not water soluble and can deposit at the site of nerve inflammation for longer periods. Non-particulate steroids are smaller and do not aggregate together. Because of this, they usually provide short-term pain relief.
Common signs that patients need an epidural steroid injection include the presence of lumbar herniated discs, which involves the inflammation of the spinal nerve root. Spinal stenosis, which is the compression of nerve roots via the narrowing of bony openings, or neurogenic claudication which is back or leg pain that is felt when the person walks long distances.
There are certain conditions that make it riskier for epidural steroids, including the presence of tumors or cancer, any bleeding disorders, or infections to any part of the body.
Osteoporosis is another condition that makes epidural steroid injections risky. With thinning, weakened bones, the individual is at a greater risk of bone breaks and fractures.
Epidural Complications After Labor and Delivery
There have been occasional suggestions that epidurals can harm the baby. According to existing research, there is no evidence that this is the case.
Epidural complications after birth are uncommon. The level of medicine that reaches the baby via the mother is so miniscule, it does not cause any harm.
Others have thought that an epidural will slow down the labor process and increase the likelihood of the woman needing a C-section. This is yet another claim that lacks evidence. A C-section is required for other reasons, mainly due to birthing a large baby or the mother having other preexisting issues.
If anything, epidurals may speed up the labor process for some women.
As far as the birthing experience itself, some women are afraid that there will be excessive numbness felt in their legs and they won’t be able to push or feel the contractions properly. Although walking immediately after the epidural isn’t usually recommended (depends on the hospital’s policy), a woman’s legs should not be so numb that they will not feel the birthing process.
Modern medicine ensures that the patient gets just enough medication for relief without inhibiting the usage of their limbs. For most patients, their epidural anesthesia won’t even cause them to feel overly groggy or fatigued.
The final labor and delivery related notion is that epidurals can cause permanent damage in the mother. This is also patently untrue. Labor epidural complications are not the norm, as instances of paralysis or other chronic conditions are almost unheard of. For that matter, any prolonged feeling of discomfort is unusual. These feelings are almost always temporary.
Final Thoughts
Post epidural complications do exist, but their scarcity is in large part to the magnificent advancements in modern medicine. Advancements in technology allow for safer and more precise injections that carry a rock bottom low risk profile.
Regardless of a patient’s reason for needing epidural anesthesia, the process can happen in seamless fashion. Physicians are able to monitor the status of their patients in real-time during the procedure, ensuring that any potential hazards are obfuscated quickly.
It’s always wise to speak with your doctor if you have any underlying conditions or additional concerns, but you should be confident in knowing that modern-day epidurals are a medical miracle, providing hassle-free pain relief when you require it most.