Epidural narcosis: consequences, contraindications, complications, reviews

Every day a large number of operations are performed in medical clinics. Surgery is impossible without proper anesthesia, that is, anesthesia is necessary, otherwise it will be unbearable to endure such pain. There are many types of anesthesia. In the article we will understand what epidural anesthesia is, in what cases it can be used, whether there are contraindications.

What is epidural anesthesia

This type of anesthesia is one of the methods of regional anesthesia. An epidural narcosis is the introduction of drugs directly into the epidural space of the vertebral column through a catheter. In the course of such anesthesia, it is possible to achieve the following results:

• Loss of pain sensitivity.
• The overall sensitivity decreases or disappears.
• Relaxation of muscles.

The mechanism of action of epidural anesthesia is connected with the fact that the drug penetrates through the dural couplings into the subarachnoid space, as a result of which the passage of nerve impulses is blocked.

Principle of epidural anesthesia

In humans, the vertebral column and nerve endings on the neck are in the dura mater. The epidural region is located around the membrane and runs along the spine. Nerves in the direction of the neck, arms and shoulders cross it, their inflammation leads to pain in the epidural region.

The medicine injected into this zone causes loss of sensitivity and dullness of pain. The transmission of nerve impulses is blocked, which gives such an effect.

When epidural anesthesia is used

Given that this kind of anesthesia is used during surgery in various areas of the body, we can say that the risk of application can be greater or less. For example, anesthesia of the epidural of the chest, inguinal area, legs and abdomen is less risky than analgesia in the neck and arms. The use of such an anesthesia for the head is impossible, because the innervation of this part of the body is carried out using the craniocerebral system.

An epidural narcosis is most often used:

1. As a local anesthetic if surgery is not expected, for example, during labor.
2. As a supplement to general anesthesia, it is possible to reduce the number of opioids used.
3. Epidural anesthesia is often used in cesarean section.
4. In the postoperative period for the removal of the pain syndrome.
5. For the treatment of back pain. In this case, steroid drugs and analgesics are injected into the epidural region.

What kind of anesthesia to give preference to general anesthesia or epidural, the doctor decides in each case.

Methods of epidural anesthesia

Every year in the arsenal of physicians there is more and more new means for the implementation of this type of anesthesia. When the doctors have a choice: general or epidural anesthesia, then, if possible, choose the latter. A large selection of drugs for its conduct allows you to choose the most suitable option for each patient.

In addition to the variety of drugs for anesthesia, there are various ways of such anesthesia:

1. Continuous. In this case, the anesthetic is injected into the cerebrospinal space permanently. This way you can achieve the removal of pain for the entire period of the operation, and the medication will be required while this is less.
2. Periodic administration. The receipt of the drug is provided only when there is an urgent need for it.
3. Anesthesia on request of the patient. When using this method, the patient has a button under his hands. If there is a need for anesthesia, when you press it into the epidural area, part of the medication is given.

Doctors have such drugs that perfectly stop the pain syndrome, but retain mobility, and the consciousness is left clear.

In what cases is an epidural anesthetic

Most surgeons consider this method of anesthesia to be the most suitable during the operations on the legs. It allows not only to remove the pain syndrome and relax the muscles as much as possible, but also to reduce blood loss.

Indications for the use of epidural anesthesia can be of a different nature, for example:

1. This method is absolutely safe for the kidneys and the prostate gland.
2. It is used for abdominal and pelvic organs.
3. Widely used during surgery on the stomach, intestines.
4. It can be used for heart diseases and diabetes mellitus.

But this does not mean that epidural anesthesia is always used in such pathologies. Everything is decided in each case individually.

Contraindications for use

Epidural narcosis of contraindication has the following: categorical and relative. The first category includes:

• The presence of tuberculosis spondylitis or its complications.
• Inflammatory process on the back.
• Shock state as a result of trauma.
• In the presence of hypersensitivity to the drugs used.
• Pathologies of the nervous system.
• If the spine is severely deformed.
• The process of blood clotting is broken.
• There are serious diseases of the abdominal cavity.
• Intestinal obstruction.

Relative contraindications are much more extensive, they include:

• Excess weight.
• Bad state of the body.
• Chronic diseases of the spinal column.
• Childhood.
• Neurological diseases.
• Pronounced hypotension and many others.

The quality of epidural anesthesia will depend not only on the existing pathology and the state of the patient's health, but also on the preparation that is to be used.

Epidural anesthesia in cesarean section

When there are all indications for conducting cesarean section, often epidural is used instead of general anesthesia . This method is chosen in advance, since it requires some preparation.

The introduction of the drug is made at a certain place at the level of the waist, where the nerve endings from the spinal cord come out. The drug is injected through a special tube-catheter, during the operation at any time, you can add the medicine.

As a result of such anesthesia, the consciousness remains clear, and the sensitivity below the waist disappears. A woman can see and hear doctors, but does not feel pain.

When there is a choice - epidural or general anesthesia with caesarean section - it is worth considering the indications and contraindications for anesthesia.

Indications for such anesthesia

Most often, epidural anesthesia is used:

1. If the labor activity began ahead of time, for example, at 36-37 a week. Such anesthesia relaxes the pelvic muscles, and the baby's head experiences less heavy loads during the movement through the birth canal.
2. Severe hypertension.
3. Discoordination of labor, when different parts of the uterus contract with varying intensity. Epidural anesthesia can reduce the intensity of contraction.
4. With prolonged labor, when there is no full relaxation for a long time. This can lead to abnormalities of labor, so use epidural anesthesia so that the woman gained strength.

Contraindications

In addition to the indications, in the case of caesarean section there are also contraindications for such anesthesia, they include:

• The presence of an inflammatory process at the puncture site.
• Infectious diseases.
• Allergic reaction to drugs.
• If there is a scar on the uterus.
• If the child is located transversely or occupies an oblique position.
• Narrow pelvis of the woman in childbirth.
• The big weight of the kid.
• If the woman herself does not want this type of anesthesia, then doctors can not use it against her will.

Before applying epidural anesthesia, the consequences, disadvantages and benefits should be taken into account.

Benefits of epidural anesthesia in cesarean section

The advantages of this type of anesthesia include:

1. A woman is conscious throughout the operation, there is no risk of intubation or aspiration.
2. No irritation of the upper respiratory tract, as with general anesthesia, which is particularly preferred for asthma patients.
3. The cardiovascular system works stably, since the drug acts gradually.
4. The relative ability to make movements is preserved.
5. With this anesthetic, you can increase the time of anesthesia, because an anesthetic is injected through the catheter at any time.
6. After the operation, opioid preparations can be administered to relieve the pain syndrome.

In addition to the pluses, it is necessary to note the shortcomings of such anesthesia.

Disadvantages of epidural anesthesia

Any method of surgical intervention, as well as anesthesia, has its drawbacks. The disadvantages of epidural analgesia include:

1. An anesthesiologist's mistake when administering the drug, when the medicine enters the interior of the vessel. This can lead to seizures, a sharp drop in blood pressure.
2. There is a danger of subarachnoidal injection, as a result of which a total spinal block develops.
3. To carry out such anesthesia you need to have a good skill, as this anesthesia is the most difficult.
4. The drug begins to act only after 15-20 minutes, so surgery can not begin immediately.
5. There is a risk of inadequate anesthesia, when the nerve endings are not completely blocked, and discomfort remains during the operation.
6. It is necessary to select carefully the preparations for such anesthesia during caesarean section, as some can penetrate the placenta and cause disruption of the breathing and heart rhythm of the fetus.
7. After the operation, pain in the back, a headache can be felt.

To make the right choice, if you have a cesarean section, epidural or general anesthesia, you need to weigh all the pros and cons. Take into account existing contraindications and choose the most appropriate type of anesthesia.

Complications of epidural anesthesia

An epidural narcosis complicates rather seldom, although such cases occur. Most often noted:

1. In 1 out of 20 patients, the drug does not work until the end, and the nerve endings are not completely blocked, which means that anesthesia will be ineffective.
2. If there is coagulopathy, there is a risk of hematoma formation.
3. Accidental damage during puncture of the dura mater can lead to the outflow of cerebrospinal fluid into the epidural region. This is fraught with a headache after surgery.
4. A large dose of pain medication may be toxic, which will result in ineffective blockade.
5. There may be side effects from the use of specific pain medications.

From all of the above, we can conclude that epidural anesthesia effects are severe for health in very rare cases.

Reviews about the use of epidural analgesia

Each organism is individual, therefore, if some are well tolerated by general anesthesia, then for others, epidural anesthesia is preferable. The reviews he has are mostly good.

Most patients note the good quality of anesthesia, women during caesarean section can see all the actions of doctors and hear the cry of their baby immediately after his birth. There is a good opportunity to significantly reduce the pain syndrome after surgery.

Many parturient women say that in the presence of high blood pressure, the use of epidural anesthesia makes it possible to keep the rates within the limits of the norm, which only positively affects the labor activity.

But without negative feedback also does not do. Some patients after such anesthesia feel a strong headache, pain in the back. There are also those on which the drug simply did not work, and the blockade of nerve endings did not occur.

Looking through all the reviews, you can draw only one conclusion: any kind of anesthesia requires a competent approach to the specialist. Even if you treat negligently to the simplest anesthesia, do not calculate the dosage of the medicine, you can get undesirable consequences, sometimes even very serious ones, and what to say about epidural.

All questions must be discussed with the doctor in advance, so that later there will be no undesirable manifestations.

Of course, it would be perfectly ideal if no one needed surgery, which means anesthesia would not have been necessary. But our vital realities are such that sometimes operations can not be avoided in order to preserve life and health. Take care of yourself and be well.