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Epidural Anaesthesia
Epidural Anaesthesia places a fine catheter in the epidural space of the spine - providing continuous, adjustable pain relief for labour, major surgery, or post-operative recovery that can be maintained for hours or days without the risks of repeated spinal injections.
Overview
Epidural Anaesthesia is administered by advancing a Tuohy needle into the epidural space using the loss-of-resistance technique, threading a soft catheter through the needle, and securing it in place for continuous or intermittent drug delivery. Local anaesthetics and opioids infused through the epidural catheter block nerve transmission from the chest or abdomen downward - providing superior post-operative analgesia after major thoracic, abdominal, and lower limb surgery that significantly reduces systemic opioid requirements, facilitates earlier mobilisation, and improves surgical recovery outcomes.
Types of Epidural Techniques
The specific approach and drug regimen are tailored to the indication, anatomical level, and duration of analgesia required.
- Lumbar Epidural (most common - for labour, LSCS, lower abdominal and lower limb surgery)
- Thoracic Epidural (for thoracic and upper abdominal surgery - superior post-operative analgesia)
- Cervical Epidural (for cervical spine and upper limb procedures - specialised use)
- Patient-Controlled Epidural Analgesia (PCEA - patient activates boluses within safety limits)
- Combined Spinal-Epidural (CSE - spinal for rapid onset, epidural for maintenance)
Risk Factors for Epidural Complications
Identifying risk factors ensures the epidural is used safely and that the benefit outweighs the risk for each individual patient.
- Coagulopathy or anticoagulant therapy - risk of epidural haematoma requiring emergency surgery
- Previous spinal surgery creating scar tissue around the epidural space
- Spinal deformity (scoliosis, kyphosis) making correct needle placement technically challenging
- Systemic sepsis or local skin infection at needle insertion site
- Patient inability to remain still or cooperate during needle placement
- Thrombocytopenia - platelet count below 80,000 requires specialist haematology assessment
Indications for Epidural Anaesthesia
Epidural anaesthesia provides superior pain control compared to systemic opioids in several high-pain surgical scenarios.
- Labour analgesia - the most effective pain relief available for childbirth
- Caesarean section when a spinal is contraindicated
- Major thoracic surgery (oesophagectomy, lung resection)
- Major abdominal surgery (bowel resection, liver surgery, radical cystectomy)
- Major orthopaedic lower limb surgery (bilateral knee, hip fracture repair)
- Thoraco-abdominal aortic surgery requiring post-operative intensive analgesia
- Post-operative pain management after major abdominal or thoracic procedures
- Chronic pain management in selected patients with spinal pain syndromes
Key Benefits
Discover the advantages of choosing our epidural anaesthesia services.
Superior post-operative pain control reducing opioid consumption and side effects
Continuous adjustable analgesia maintained throughout the post-operative recovery period
Most effective pain relief for labour allowing mothers to remain alert and active
Thoracic epidural dramatically reduces pulmonary complications after major surgery
Earlier mobilisation and physiotherapy facilitated by superior epidural pain control
Clinical Features
The technology, techniques and clinical approach behind our epidural anaesthesia.
Loss of resistance technique provides reliable confirmation of epidural space entry
Test dose before therapeutic dosing detects intravascular or intrathecal misplacement
Soft catheter allows continuous adjustable drug delivery for hours or days
Daily acute pain service ward rounds monitor and optimise the epidural infusion
PCEA allows patient-driven dose supplementation within safety limits
Preparation Instructions
Notify the nursing team immediately for any sudden back pain, weakness in the legs, loss of bladder control, or fever during epidural infusion - these symptoms require urgent medical assessment. Do not attempt to stand without nursing assistance while the epidural is active. After catheter removal, any new neurological symptoms in the 24 hours following removal must be reported urgently. Mild backache at the insertion site for 2 to 3 days after removal is normal and managed with paracetamol.
The Procedure
Step-by-step guide to what you can expect during your epidural anaesthesia procedure.
Positioning and Identification
You are positioned sitting forward or lying on your side. The anaesthesiologist identifies the correct interspace by palpating the spinous processes before beginning.
Loss of Resistance Technique
Local anaesthetic numbs the skin and deep tissues. The Tuohy needle is advanced through the ligamentum flavum -- the loss of resistance to syringe pressure confirms entry into the epidural space.
Catheter Threading and Fixation
A soft catheter is threaded through the Tuohy needle into the epidural space and secured with tape. The Tuohy needle is removed leaving the catheter in place for continuous drug delivery.
Test Dose and Initial Relief
A test dose confirms correct catheter placement. The therapeutic dose is administered through the catheter. For labour epidurals pain relief develops progressively over 15 to 20 minutes.
Ongoing Management
The epidural infusion is monitored and adjusted by the acute pain team throughout the admission. Patient-controlled epidural analgesia allows patient-driven supplemental doses within safety limits.
Catheter Removal
The catheter is removed when no longer needed and a short monitoring period confirms no complications. Mild backache at the insertion site for 2 to 3 days is normal and managed with paracetamol.
What to Expect
The epidural catheter is placed with you sitting forward or lying on your side. After local skin anaesthesia, the Tuohy needle is carefully advanced and the catheter threaded into the epidural space. A test dose confirms correct placement before the therapeutic drug infusion begins. For labour epidurals, pain relief develops within 15 to 20 minutes. Post-operative epidurals are managed by the acute pain team who visit daily to assess and adjust the infusion.
Frequently Asked Questions
Common questions about epidural anaesthesia.
Related Services
Explore other services in our Anaesthesiology department.
General Anaesthesia
Spinal Anaesthesia
Regional Nerve Block
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