When an epidural is used

An epidural is a type of local anaesthetic. It can be used to completely block pain while you are awake.

This has the advantage of allowing you to avoid the potential complications and common side effects of general anaesthetic, such as feeling sick and dizzy.

Epidural anaesthesia can be used to numb sensation and provide pain relief in situations including:

• during childbirth
• during a caesarean section where a baby is delivered through a cut made in the abdomen
• after surgery that has been carried out under general anaesthetic
• during other types of surgery such as knee surgery, hip replacement surgery, rib or chest fractures, and amputation of the lower limbs

Epidurals are most commonly associated with pain relief during labour and childbirth. This topic focuses mainly on this use of epidural anaesthesia.

Labour and childbirth

Your midwife and anaesthetistcan advise youon having an epidural during labour and childbirth, and whether they think its necessary.

However, remember that the final decision will be yours.

An epidural may be recommended during:

• a particularly painful, complicated or prolonged labour
• the delivery of twins or triplets
• a caesarean section delivery if an epidural was given during labour
• an assisted delivery where either forceps or a suction cap (ventouse) is attached to the baby's head to help with the delivery

A smaller amount of local anaesthetic is used in combination with other painkilling medicines.

As your nerve sensations are not completely blocked, a mobile epidural gives pain relief without as much of the numbness or heavy-legged feeling thats experienced during a full epidural.

Another advantage of a walking epidural is that you will be able to feel the contractions and the need to push during the final stages of labour.

As you still have some sensation in your legs, you can also move around if you need to, although its not always recommended.

Why epidurals might not be used

In rare cases, an epidural isnt recommended. For example, it may not be suitable if you:

• are allergic to local anaesthetics
• are taking medicines to thin your blood, such as warfarin
• have a blood-clotting abnormality that increases your risk of bleeding
• have previously had back surgery, or you have other problems with your back
• have a spinal deformity or severe arthritis in your spine
• have a neurological condition that affects your nervous system, such as spina bifida

Your anaesthetistcan provide you with more information and discuss the potential risks in these situations.