Last updated: 11/24/2009

To prepare for the administration of epidural anesthesia, the woman should have the procedure explained fully and sign consent forms if required. An intravenous line is inserted, if not already in place. She is positioned on her side or in a sitting...

position and connected to a blood pressure monitoring device. The nurse/assistant has the following equipment available: oxygen, epidural insertion equipment, fetal monitor, and additional intravenous fluid.

The health-care provider cleans the area with an antiseptic solution, injects a local anesthetic to create a small wheal at the L 3–4 area (between the third and fourth lumbar vertebrae), and inserts a needle into the epidural space. Once it is ascertained that the needle is in the correct place, a polyethylene catheter is threaded through the needle. The needle is removed and a test dose of the anesthetic agent is administered. The catheter is taped in place along the patient's back with the end over her shoulder for easy retrieval when further doses are required.

If the patient responds well to the test dose, a complete dose is administered. Pain relief should come up to the level of the umbilicus. The epidural anesthesia lasts approximately 40 minutes to two hours, or longer as required. If necessary, additional doses of anesthetic, or top-up, are injected through the catheter or by continuous infusion on a special pump.

Epidural anesthesia can be given in labor in a "segmented" manner. In this instance, the laboring woman receives a small dose of anesthesia so that the perineal muscles do not fully relax. The baby's head is more apt to undergo internal rotation when the perineal muscles are not too loose, thus facilitating delivery. At the time of delivery, an additional dose can be administered for perineal relief.

Women who have cesarean deliveries may have additional medication injected into the epidural space to control intra-operative pain. Medications generally used are such narcotics as fentanyl or morphine (Duramorph). Side effects include severe itching, nausea, and vomiting. Treatment of these side effects with the appropriate medication can be helpful. Despite these problems, epidural analgesia is an effective method to relieve pain after cesarean delivery, allowing the woman to move easily and speed recovery.

Local anesthetics are generally safe when administered by the epidural route. There is a low frequency of allergic reaction to the drug. Most often the drug causes a mild skin reaction, but in more severe cases can cause breathing difficulty and an asthma-like reaction. A burning sensation at the site of injection may occur, sometimes with swelling and skin irritation. Other adverse reactions may occur if the epidural anesthetic is not properly administered.