Consequences and complications after epidural anesthesia. All about epidural anesthesia during childbirth How does epidural anesthesia affect the heart

Before we move on to explaining the mechanism of action of the anesthetic effect, let’s figure out why anesthesia exists at all. For the first time, anesthesia was used purposefully as a medical addition by the famous doctor Pirogov, who performed general ether anesthesia.

Before this, people were simply given alcohol to the point of unconsciousness or given large doses of narcotic substances such as hashish or opium. Both had serious consequences for the patient. It is fundamentally incorrect to call anesthesia anesthesia, because its task is, first of all, to ensure the vital activity of the body during any intervention in the human body aimed at eliminating injuries, relieving pain and recovery.

Are there complications after anesthesia?

But anesthesia is not a panacea, since while it frees the body from stress and pain shock, it can itself cause harm and cause complications if the dosage is incorrect.

Everyone is familiar with the contract that is signed at a medical institution when an operation is planned. It contains a clause clearly indicating that the institution does not take responsibility for the consequences of anesthesia. During the interview, the anesthesiologist always first finds out whether the patient has an individual intolerance to any drugs, the frequency of operations, or previous diseases; A cardiogram and all tests are required; talks about the reaction that can occur after anesthesia. Even a fairly healthy person may experience discomfort or complications. Coming to consciousness in the postoperative unit, almost every patient feels unwell.

Symptoms of anesthesia transfer are:

general weakness;
nausea or vomiting;
pain in the head and muscles;
sore throat and confusion;
severe drowsiness and sweating.

It is less common for a patient to regain consciousness during surgery. In this case, complications of anesthesia may include injuries to the lips and tongue, bronchopulmonary infections.

Isolated cases after anesthesia include damage to nerve endings, eyeballs or their trauma, reactions such as anaphylactic shock and death of brain cells.

Many side effects can be avoided if you strictly follow the doctors' recommendations - once you regain consciousness after surgery, you cannot drink (this will cause vomiting), nausea can be relieved by moistening your lips in acidified lemon water. A sore throat goes away on the second day at most. Chills are also not dangerous, since they last no more than half an hour; it is enough to cover the patient with a warm blanket.

How does epidural anesthesia work?

Epidural anesthesia is the introduction of painkillers into the epidural space of the spinal canal through a special catheter. This type of anesthesia is regional, because medications affect only certain groups of nerves and block the transmission of pain impulses through them to the cerebral cortex.

How long does epidural anesthesia last?

The duration of spinal anesthesia is limited by the duration of action of the local anesthetic that is given by injection, approximately one to four hours. But epidural anesthesia is not limited in time and it lasts as long as the local anesthetic is administered through the catheter. This is very convenient and allows you not only to anesthetize the operation, but also to relieve the patient from pain in the postoperative period.

Often the anesthetic and glucocorticosteroids.

Is epidural anesthesia included in the birth certificate?

It depends on the circumstances.

If epidural anesthesia is performed according to indications, it is included in the birth certificate. In this case, this type of medical care is provided free of charge.

But epidural anesthesia can also be performed at the request of the woman herself. In this case, it is an additional paid service that will have to be paid in full.

Is epidural anesthesia used during laparoscopy?

Epidural anesthesia is performed during laparoscopic surgical interventions, including in gynecology. But it can only be used for short-term procedures and those that are performed on an outpatient basis (without hospitalization). Disadvantages of epidural anesthesia during laparoscopic operations:

• Higher risk of oxygen deprivation due to increased levels of carbon dioxide in the blood.
• Irritation phrenic nerve, whose functions are not disabled during epidural anesthesia.
• The possibility of aspiration is the entry of saliva, mucus and stomach contents into the respiratory tract as a result of increased pressure in the abdominal cavity.
• With epidural anesthesia, it is often necessary to prescribe strong sedatives, which can suppress breathing - this further increases oxygen deprivation.
• Higher risk of cardiovascular system dysfunction.

In this regard, epidural anesthesia has limited use in laparoscopic operations.

What drugs are used for epidural anesthesia?

Drug name	Description
Novocaine	Currently, it is practically not used for epidural anesthesia. It begins to act slowly, the effect does not last long.
Trimekain	It acts quickly (numbness begins after 10-15 minutes), but not for long (the effect stops after 45-60 minutes). Most often used for epidural anesthesia through a catheter or in combination with other anesthetics.
Chloroprocaine	Just like trimecaine, it acts quickly (numbness begins after 10-15 minutes), but not for long (the effect stops after 45-60 minutes). It is used for short-term and outpatient interventions, as well as for epidural anesthesia through a catheter (in this case it is administered every 40 minutes).
Lidocaine	It begins to act quickly (10-15 minutes after administration), but the effect lasts quite a long time (1-1.5 hours). Can be administered through a needle or through a catheter (every 1.25-1.5 hours).
Mepivacaine	Just like lidocaine, it begins to act in 10-15 minutes and ends in 1-1.5 hours. It can be given through a needle or through a catheter, but this drug is not recommended for long-term pain relief during labor because it enters the bloodstream of the mother and baby.
Prilocaine	The speed and duration of action are the same as lidocaine and mepivacaine. This drug is not used for long-term pain relief and in obstetrics, as it negatively affects the hemoglobin of the mother and fetus.
Dicaine	It begins to act slowly - 20-30 minutes after administration, but the effect lasts up to three hours. This is enough for many operations. But it is important not to exceed the dose of the anesthetic, as otherwise its toxic effects may occur.
Etidocaine	It begins to act quickly - within 10-15 minutes. The effect can last up to 6 hours. This drug is not used in obstetrics, as it causes severe muscle relaxation.
Bupivacaine	It begins to act in 15-20 minutes, the effect lasts up to 5 hours. In low doses, it is often used to relieve pain during labor. This anesthetic is convenient because it acts for a long time and does not lead to muscle relaxation, so it does not interfere with labor. But with an overdose or injection into a vessel, persistent toxic effects develop.

What medications can affect epidural anesthesia?

Taking medications that reduce blood clotting is a relative contraindication to epidural anesthesia. A certain amount of time must pass between taking the medication and the procedure for its effects to wear off.

Drug name	What should you do if you are taking this drug*?	What tests need to be done before epidural anesthesia?
Plavix (Clopidogrel)	Stop taking 1 week before anesthesia.
Tiklid (Ticlopidine)	Stop taking 2 weeks before anesthesia.
Unfractionated heparin(solution for subcutaneous administration)	Conduct epidural anesthesia no earlier than 4 hours after the last injection.	If treatment with heparin lasted more than 4 days, it is necessary to take a complete blood count and check the platelet count.
Unfractionated heparin(solution for intravenous administration)	Conduct epidural anesthesia no earlier than 4 hours after the last injection. Remove the catheter 4 hours after the last insertion.	Definition prothrombin time.
Coumadin (Warfarin)	Conduct epidural anesthesia no earlier than 4-5 days after discontinuation of the drug.	Before administering anesthesia and before removing the catheter: definition prothrombin time; definition international normalized relations(blood clotting indicator).
Fraxiparine, Nadroparin, Enoxaparin, Clexane, Dalteparin, Fragmin,Bemiparin, Cibor.	Do not enter: in a prophylactic dose – 12 hours before the procedure; in a therapeutic dose – 24 hours before the procedure; after surgery or catheter removal - within 2 hours.
Fondaparinux (Pentasaccharide, Arixtra)	Do not administer within 36 hours before anesthesia; do not administer within 12 hours after completion of surgery or catheter removal.
Rivaroxaban	Epidural anesthesia can be administered no earlier than 18 hours after the last dose; administer the drug no earlier than 6 hours after completion of the operation or removal of the catheter.

*If you are taking one of these medications, be sure to tell your doctor. Do not stop taking it yourself.

Today, almost every maternity hospital offers pregnant women epidural anesthesia during childbirth. It injects a woman in labor into the back at a certain stage of the birth process, relieves pain and alleviates the condition of the expectant mother. However, this procedure may not be suitable for everyone. There is a certain category of women for whom spinal anesthesia is contraindicated. In this article we will talk in detail about what epidural anesthesia is, how it is performed and why it is dangerous.

Epidural anesthesia is a type of local anesthesia. It relieves pain from contractions, which are sometimes simply unbearable for a woman.

Anesthesia is injected into the lumbar spine, where the epidural space is located. It contains the spinal roots of the nerve endings of the pelvic organs, which include the uterus. Anesthesia blocks pain, and a woman may not feel any unpleasant symptoms for a long period of contractions. In this matter, you need to choose the right dosage for the woman in labor so that she does not feel painful contractions, but at the same time can walk independently and be conscious. By the way, today epidural anesthesia is widely used for caesarean section, which allows mothers to see the birth of their child, even if she cannot give birth naturally.

It should be noted that during natural childbirth, the effect of epidural anesthesia lasts only during contractions, when the cervix opens so that the baby can pass through the birth canal. The woman is forced to endure the pushing without pain relief, but it does not last long, so it can be tolerated.

If a woman needs to use epidural anesthesia purely for medical reasons, then she will be given it free of charge, but if she simply expresses a desire to give birth under anesthesia, then she will have to pay for it separately.

How is epidural anesthesia given?

The technique of epidural anesthesia is quite complex, although the process of administering spinal anesthesia takes only 10 minutes. It requires a highly qualified anesthesiologist and adherence to strict rules:

1. A pregnant woman should bare her back, sit down, or lie on her side so that the doctor has access to the puncture site. It is very important to freeze in the chosen position, because unnecessary body movements can lead to many complications.
2. The doctor treats the area that will be pierced with a special antiseptic.
3. After this, the anesthesiologist numbs the area that will be pierced. For this, banal Lidocoin is used.
4. After this, a special kit for epidural anesthesia is used - a special needle with anesthesia is inserted (it will take effect 20 minutes after injection). It must reach the dura mater. A special tube is inserted into the needle - a catheter, which will be in the back of the woman in labor until she pushes. Just keep in mind that anesthesia cannot be administered at the moment of contraction. If you feel that a contraction is approaching, then tell your doctor, because during the moment of spasm you can move, and this will lead to detrimental consequences.
5. After childbirth, the catheter is removed from the woman's back, but for 2-3 hours after epidural anesthesia, the doctor will recommend that the woman in labor remain motionless.

Epidural anesthesia during childbirth can be administered to a woman in two ways:

1. Gradually, introducing small doses.
2. Once, administering the entire dose of the drug at once. With this method, the woman cannot get up, because the components of anesthesia will dilate the blood vessels in the legs, and the woman in labor will simply not be able to walk.

Epidural anesthesia is absolutely safe for the child. Painkillers do not enter his blood, so the placenta does not absorb them.

Indications for epidural anesthesia in the maternity hospital

Western medicine practices epidural anesthesia all the time. As soon as women come to arrange childbirth, they are immediately offered to use local anesthesia. Domestic medicine recommends the use of spinal anesthesia only for strict medical indications:

• If a woman goes into premature labor. With a relaxed cervix under anesthesia, it will be easier for a premature baby to pass through the birth canal.
• If a woman’s labor is so weak that there are contractions but no dilatation.
• If a woman in labor has too high blood pressure, at which the woman cannot give birth herself. Epidual anesthesia, according to reviews, perfectly reduces blood pressure.
• If a woman has a multiple pregnancy or her baby is too large, as a result of which she cannot give birth on her own, and general anesthesia is contraindicated, spinal anesthesia is suggested.
• If labor is prolonged and the pregnant woman can no longer endure labor pains, then she is given anesthesia.

Contraindications to epidural anesthesia

• vegetative-vascular dystonia in a pregnant woman;
• deformed spine, which complicates the puncture process;
• there are rashes on the skin in the area where the puncture will be performed;
• blood problems (poor clotting, infection);
• bleeding;
• individual intolerance to anesthesia components;
• the woman is unconscious;
• heart or vascular diseases;
• Epidural anesthesia is not given for lumbar spinal hernia.

Complications of epidural anesthesia

After epidural anesthesia, a woman may experience some complications:

1. The doctor may accidentally enter the venous bed of the spine, and then the woman will begin to have headaches after the administration of epidural anesthesia, she will feel nauseous, and her tongue will become numb.
2. Anaphylactic shock may occur (this occurs if the woman does not know that she has an allergy).
3. Quite rarely, a consequence of epidural anesthesia such as difficulty breathing occurs.
4. In addition, women in labor often complain of back pain after epidural anesthesia. Your back may hurt for several days after giving birth. If the pain does not stop after epidural anesthesia, then doctors must make a puncture again in the place where the anesthesia was administered in order to inject the woman’s blood there, which will seal the puncture site.
5. After epidural anesthesia, legs may be paralyzed, but this only happens if the technology for administering anesthesia was carried out incorrectly.
6. After giving birth with an epidural, a woman may have difficulty urinating.

To avoid negative consequences after an epidural, you need to weigh the pros and cons of the procedure. We will tell you more about this later.

Epidural anesthesia: pros and cons

The main advantages of spinal anesthesia during childbirth include:

• the ability to make childbirth painless and comfortable;
• if labor is delayed, the woman can even sleep after epidural anesthesia;
• Women in labor with high blood pressure may not be afraid to give birth on their own using spinal anesthesia.

The main disadvantages of epidural anesthesia:

• some complications may arise due to the incompetence of the doctor or the sudden movement of the woman during the puncture;
• the mother may lose the psycho-emotional connection with the child, although this fact has not been proven.

Your main task is to listen carefully to the doctor about what to do after epidural anesthesia. Following your doctor's recommendations will help prevent possible complications and ensure proper recovery after spinal anesthesia.

Video: “Epidural anesthesia”

May increase the mother's temperature during labor, which can be a dangerous side effect for the baby, especially if the temperature rises above 38°C. The mechanism of fever with the introduction of epidural anesthesia has not been studied. Fever can occur during childbirth without its use. But when using it, the risk of a febrile state increases by 3 times in 2.5-7.5% of women in labor, and this, in turn, increases the risk of neurological injuries and the risk of a neurological disease in the baby increases by 3-9 times.

After childbirth with the use of epidural anesthesia, post-puncture headache (PDPH) occurs in 15% of cases on the first day. It stops after 3-5 days, but can last for several months and years. Women in labor may feel neurological disorders in the legs, perineum and buttocks for 3-5 days or more in the form of pain: dull, pulling or throbbing (10-37%).

When anesthesia is administered, blood pressure may drop, which is overcome by introducing boluses (solutions) or ephedrine into the bloodstream.

Refusal to eat and drink before anesthesia is the golden rule of safe anesthesia. If the stomach is full, then its contents can enter the lungs, since no one is immune from nausea and vomiting after epidural anesthesia. Therefore, you need to eat your last meal at lunchtime. Water is excluded at night and on the day of anesthesia.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

In this article:

Every woman is subconsciously afraid of labor pain. Despite the preparatory stages, prenatal gymnastics and a good emotional mood, the feeling of fear and pain still haunts the woman until the last moment. Very often, the expectant mother is negatively influenced by acquaintances or friends who like to talk colorfully about their childbirth and the consequences after it. You should try to avoid these “horror stories” and not allow the slightest fear. The calmer the woman in labor, the easier and faster everything goes.

Epidural anesthesia during childbirth comes to the aid of modern expectant mothers, which helps to simplify all the natural mechanisms of childbirth. With its help, a woman can more easily endure contractions and all labor pains, if all this becomes an unbearable burden for the woman in labor.

Epidural anesthesia - what is it?

Epidural anesthesia is aimed at the action of the spinal region, where special spinal roots with nerve impulses pass. All of them are related to the pelvic organs, including the uterus itself. When an epidural is administered, all these nerve impulses are blocked and do not transmit pain signals to the brain. Thus, the woman in labor ceases to experience painful sensations or they are felt to a minimal extent.

Often such anesthesia is aimed at easing contractions and giving the woman in labor a break before the birth itself. Doctors are very careful in calculating the dose to be given. This helps relieve pain without immobilizing the person. Women continue to be conscious and active even during childbirth.

Epidural anesthesia works primarily during dilatation of the cervix. Doctors try to carry out pushing and prenatal hours in a natural way, so as not to negatively affect the health of the mother and child.

How is spinal anesthesia different?

Spinal and epidural anesthesia are very similar in their effects on the body, only spinal anesthesia is injected deeper into the cerebrospinal fluid. This drug can act as an anesthetic in a completely different way and, naturally, a person’s reaction and behavior to pain with it is also different.

Spinal and epidural anesthesia differ only in the time frame and a deeper effect on the nerve endings. This drug is considered safer and gentler among doctors.

The prices for these drugs are approximately the same. If a woman gives birth in a regular maternity hospital, then this type of anesthesia should be provided free of charge. In a private clinic, such a service may require from 3 to 5 thousand rubles.

How is epidural anesthesia given?

If a woman in labor needs this anesthesia, she will have to go through a series of small steps to administer the drug. First of all, the woman is placed on her side, her back is slightly bent using the “curl” position, and an anesthetic is injected into the spine. Most often, the procedure is performed by several doctors so that the patient does not move unnecessarily and does not create additional problems.

Additionally, the site of the future puncture can be numbed and must be wiped with alcohol or some other antiseptic drug. To deliver pain relief gradually, an additional catheter may be inserted into the spine, which will be able to withstand the pain of labor throughout the entire process.

If, when a catheter is inserted, a woman begins to experience strong contractions, then it is best to abandon this option and not prevent the woman in labor from doing everything on her own. During the administration of the drug, various negative changes in the body may also occur. Nausea, dizziness, and numbness of the body are possible. If such symptoms begin, you should immediately inform your doctor.

The entire procedure of puncturing the spine and inserting a catheter into the body will take no more than 10 minutes by experienced doctors. Many expectant mothers, with trepidation and fear, begin to ask questions the day before: “does it hurt to have epidural anesthesia” or “does my back hurt after epidural anesthesia?” However, do not worry, the most unpleasant thing is to endure a few not entirely comfortable seconds during the puncture. All subsequent actions of doctors will simply not be noticeable by the body. The installed catheter will not interfere with the birth process and will not fall out of the back at the most crucial moment. Often the drug can be administered in different doses and at different time periods. All this directly depends on the condition of the woman in labor and her individual characteristics of the body.

Expectant mothers also should not worry about the entire process of labor with this drug. Nowadays, scientists have proven that such an anesthetic does not have time to penetrate through the placenta into the child’s blood. Thus, epidural anesthesia has no consequences for the child.

But epidural anesthesia during childbirth will have consequences for the mother herself. A woman cannot fully control her pain and her natural sensations during childbirth. Some doctors treat this drug with distrust, since the speed of cervical dilatation increases significantly, but the attempts themselves become weak and unnatural. Thus, the epidural technique may have little impact on the entire labor process and activity.

Indications and contraindications

The indications and contraindications for this anesthetic can be quite different. It all depends on the course of pregnancy and its complexity. Let's take a closer look at the cases in which the drug can have a positive or negative effect on labor and the future health of the woman in labor.

Indications:

1. It can be actively used in premature pregnancy. With the help of the drug, doctors cause active natural relaxation of all pelvic muscles and childbirth takes place in more gentle and natural conditions. Thus, the mother will not experience excessive pain due to the fact that her body did not have time to prepare for this process in advance.
2. Incorrect coordination of labor. In such a case, the woman in labor experiences deep labor, but the uterus does not begin to contract or does so incorrectly. In this case, the drug can activate the muscles and help the uterus open naturally.
3. It is also actively used if a woman in labor has extremely high blood pressure. The drug helps to normalize and maintain blood pressure at the desired level during all stages of labor.
4. Unforeseen complications. Epidural anesthesia is necessary if the fetus is very large or if the pregnancy is multiple. Often the drug is also used if the expectant mother cannot be given general anesthesia for some reason.
5. You cannot do without this anesthetic even during very difficult or protracted labor. For example, Western clinics have been actively using this drug for quite a long time so as not to torment women and create less pain for them. However, our experts have a completely different opinion on this matter.

Epidural anesthesia has quite serious contraindications, which can significantly affect the health or life of the woman in labor.

Contraindications:

1. The drug is inadmissible for abnormally low blood pressure.
2. The woman in labor has any difficulties with the spine or it is unnaturally curved, which leads to difficulty inserting the catheter.
3. There are any inflammations on the back at the site of a possible puncture.
4. Allergy or intolerance to the drug.
5. Heavy bleeding during labor.
6. Mental disorders or unconsciousness of a woman during childbirth.
7. Personal refusal of the woman in labor.
8. Weak blood vessels or heart disease.

Consequences and complications

In order not to deceive women, it is necessary to clearly explain to them all the risks that they may be exposed to. Such consequences occur quite rarely, but there is still a chance of getting such a problem. Epidural anesthesia primarily causes complications directly during childbirth.

The drug may accidentally enter the veins and spread throughout the body. Then the person is guaranteed weakness and general malaise. A woman may lose control of some limbs, have difficulty speaking, lose consciousness, or experience severe dizziness. Most often, if the drug enters a vein, these symptoms occur instantly. If the woman in labor feels them, she should immediately tell the anesthesiologist about it.

The drug may cause an allergic reaction in some cases. If doctors did not know in advance the body's possible reaction to this drug, it may even develop anaphylactic shock. To avoid this, the woman is given a minimal amount of anesthesia to see how her body reacts.

“What else is dangerous about epidural anesthesia?” - you ask. Often, after using it, breathing difficulties may occur. Sometimes this is attributed to tension and efforts, but such difficulties have a slightly different nature. The anesthetic begins to actively influence the nerve endings and muscles that are located between the ribs.

In addition to difficulty breathing, severe headache and back pain may develop. Most often, such unpleasant symptoms go away within a day after birth. But in the most severe cases, this pain can last for several months. In this case, you need to treat it with medication under the supervision of a doctor. Sometimes doctors re-puncture and inject a small amount of the patient's blood to "seal" the puncture inside the spine.

All symptoms related to dizziness, nausea or weakness also disappear a few days after birth. Sometimes, to quickly remove the anesthetic from the body, the mother is given a cleansing drip.
I don't want to scare all the expectant mothers who will have to undergo this anesthesia, but there is a very small chance of paraplegia.

Failed anesthesia

In medical practice, there are cases when, after administering epidural anesthesia, a woman in labor does not feel any relief and painful symptoms do not subside. According to statistics, 5 percent of women in labor feel no relief after anesthesia, and 15 percent of all women feel only slight relief.

The reason for such unsuccessful pain relief can be a large number of different factors. First of all, this is the individuality of the body, which reacts to the drug in its own way. Also, anesthesia is often administered in the wrong place due to the inexperience of doctors or due to the fault of the woman in labor - if she moved too actively during the process. The reason for an incorrect hit can be the excessive fatness of women or the curvature of the spine.

Advantages and disadvantages

If expectant mothers no longer have any unnecessary questions about the procedure and the effect of the drug on the body, let’s more accurately analyze and weigh all the pros and cons of epidural anesthesia.

Positive points:

• the ability to make childbirth easier and make the process less traumatic and dangerous;
• the opportunity to get some relief and respite for the process of giving birth;
• the ability to prevent high blood pressure in women.

Minuses:

• various complications of varying degrees of severity;
• postpartum complications;
• consequences after epidural anesthesia.

Thus, we really see that epidural anesthesia has its pros and cons. She is able to facilitate the process of childbirth in order for a woman to endure this difficult period in her life if the body does not have enough strength and health to do this on its own. Complications after epidural anesthesia can be removed and eliminated from the body through medical interventions as quickly as possible.

Theory of emotional contact with a child

Many people believe that administering additional anesthetics is wrong. Many mothers who have successfully overcome childbirth with anesthesia do not believe this theory, but it has many positive reviews.

During childbirth, mother and child are exposed to extreme stress. And if the mother is at least in a familiar environment, then the child will learn a new world. During this difficult moment in life, both loved ones must be connected to each other and the common pain that affects both mother and baby. This will allow them to maintain an invisible emotional connection during childbirth. Doctors recommend that mothers prepare themselves for an easier birth using other ways and methods, for example, going to special gymnastics, doing breathing exercises, learning to relax and establishing an internal connection with the baby. Many mothers “agree” with their child in advance so that everything goes well and without consequences. This attitude allows mothers to more easily survive all the torments and pains of birth.

In addition, any pain, and especially severe labor pain, produces a huge amount of endorphin hormones, which are responsible for human happiness and pleasure. Thus, having gone through everything on her own without anesthesia, a woman can feel unprecedented joy and relief. And if there is no pain, then the woman will not experience joy.

Every mother must carefully weigh everything before giving birth and set herself up only for a positive result.

Useful video about epidural anesthesia