Epidural analgesia gives excellent pain relief. This pain control method usually causes less sleepiness than medicine given through your IV or as a shot. Epidural medicine stops your pain early and blocks its path to your brain. Patients may have shorter hospital stays and fewer problems after surgery when they have epidural analgesia.
Epidural pain control may be used for almost any surgery below your upper chest. Patient having surgery on the aorta, gallbladder, prostate, knee, and hip can find this type of pain control valuable. Women who have hysterectomies could find this a good method of pain relief; children too can benefit from this method of pain control.
For many years, epidurals have been used for pain relief in childbirth. Now, epidurals are used in a number of postoperative settings including lower extremity orthopedic operation, major operations on the chest and abdomen, and certain urological procedures. We can use an epidural for pain control after your surgery by attaching the epidural catheter to a small, computerized pump.
This technique involves the insertion of a small sterile catheter in the back, into the space between the spinal cord and outer membrane of the spinal cord (epidural space). The epidural catheter is placed at or below the waist. It is taped in place up the center of your back with the end taped in place on top of your shoulder.
Local anesthetic is dripped through the catheter and numbs the nerve roots as they enter the spine continuously to help keep comfortable by numbing a narrow area of lower abdomen. If needed, the block may be extended to include peritoneum.An epidural can result in complete loss of all sensation and movement (from the chest down) or just reduce pain without any affect on movement, depending on the concentration of the anesthetic used.
The catheter will be taped up your back to your shoulder. You may lie on your back without causing any problems. A small pump (which is about the size of a transistor radio or Walkman) will be attached to your catheter after surgery. We use two types of pain medicine to block your pain after surgery: opioids (commonly called narcotics) and local anesthetics. The pain medicine is absorbed through the epidural space, into the nerve roots, in your back . . . hour after hour . . . which diminishes pain after surgery.
Women who receive an epidural during childbirth are more likely to have breast-feeding problems in the first week and to stop breast-feeding before the end of six months than women who don't receive an epidural, an Australian study says.
The study, published in the Dec. 11 International Breastfeeding Journal, included 1,280 women who gave birth between March 1997 and October 1997. Of the 416 (33 percent) women who had an epidural, 172 (41 percent) had a Caesarean section.
Researchers found that 93 percent of the women in the study breast-fed their baby in the first week after birth. However, women who had an epidural were significantly more likely to have difficulty breast-feeding during the first few days after delivery and to breast-feed less often than other women.
At 24 weeks, 72 percent of women who did not have an epidural were breast-feeding, compared with 53 percent who received pethidine or epidurals containing bupivacaine and fentanyl (an opioid).
The findings contribute to the growing body of evidence that the fentanyl component of epidurals may be associated with breast-feeding difficulties, the study authors said.
In an accompanying commentary, Sue Jordan, senior lecturer in applied therapeutics at Swansea University, said that the effect of opioids and epidurals on breast-feeding should be regarded as an "adverse drug reaction."
She called for "extra support to be offered to the most vulnerable women, to ensure that their infants are not disadvantaged by this hidden, but far-reaching, adverse drug reaction."
Some patients may not have the option of using this type of pain control because of other health care problems, such as taking blood thinners. You may want to ask your surgeon if epidural pain control would be good for you.Ultimately, the patient with the assistance of her obstetrician and anesthesiologist, chooses a method of pain management.
Though not all patients require pain management services from the anesthesiologist, a member of the OB anesthesia team sees and evaluates all women admitted to the Birthing center. The evaluation interview provides the woman in labor an opportunity to discuss the risks and benefits of the various pain management options. Preadmission consultation is possible and is made through your obstetrician.
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