Questions you may like to ask your anaesthetist Q Who will give my anaesthetic? Q Do I have to have this type of pain relief? Q Have you often used this type of pain relief? Q What are the risks of this type of Epidurals for pain relief? Q Do I have any special risks? Q How will I feel afterwards? pain relief after surgery Tell us what you think This leaflet is for anyone who may benefit from an epidural for pain relief after surgery. We hope it will help you to ask questions and direct you to sources of further
London WC1B 4SGemail: [email protected]information.
The Association of Anaesthetists of Great
This leaflet will be reviewed within five years of the date of publication
Epidurals for pain relief after surgery Epidurals for pain relief after surgery
This booklet explains what to expect when you have an epidural catheter placed for pain relief after your operation. It has been
written by patients, patient representatives and anaesthetists, working in partnership.
This leaflet describes what happens when you have an
You can find more information in other leaflets in the series on
epidural, together with any side effects and complications
the website www.youranaesthetic.info. They may also be
that can occur. It aims to help you and your anaesthetist
available from the anaesthetic department in your hospital.
make a choice about the best method of pain relief for you
● Anaesthesia explained (a more detailed booklet)
What is an epidural?
● You and your anaesthetic (a shorter summary)
The nerves from your spine to your lower body pass through
an area in your back close to your spine, called the ‘epidural
● Headache after an epidural or spinal anaesthetic
● Your child’s general anaesthetic for dental treatment
● To establish an epidural an anaesthetist injects local anaes-
● Local anaesthesia for your eye operation
thetic through a fine plastic tube (an epidural catheter)
into the epidural space. As a result, the nerve messages
are blocked. This causes numbness, which varies in extent according to the amount of local anaesthetic injected.
● Anaesthetic choices for hip or knee replacement
● An epidural pump allows local anaesthetic to be given
continuously through the epidural catheter. Risks associated with your anaesthetic
● Other pain relieving drugs can also be added in small
A collection of 14 articles about specific risks associated with having an
anaesthetic has been developed to supplement the patient information
leaflets. The risk articles are available on the website
The amounts of drugs given are carefully controlled. www.youranaesthetic.info.
● You may be able to press a button to give a small extra
dose from the pump. Your anaesthetist will set the pump
Throughout this booklet we use these symbols:
to limit the dose which you can give, so overdose is
● When the epidural is stopped, full feeling will return.
● Epidurals may be used during and/or after surgery for
www.youranaesthetic.info www.youranaesthetic.info Epidurals for pain relief after surgery Epidurals for pain relief after surgery How is an epidural done? 2 If you are conscious, you will be asked to sit up or lie
on your side, bending forwards to curve your back. It is
important to keep still while the epidural is put in. 3 Local anaesthetic is injected into a small area of the skin
● when you are under sedation (when you have been given
a drug which will make you drowsy and relaxed, but still
4 A special epidural needle is pushed through this numb
area and a thin plastic catheter is passed through the
● or during a general anaesthetic.
needle into your epidural space. The needle is then removed, leaving only the catheter in your back.
These choices can be discussed further with your anaesthetist. 1 A needle will be used to put a thin plastic tube
(a ‘cannula’) into a vein in your hand or arm for giving fluids (a ‘drip’). Introduction Introduction www.youranaesthetic.info www.youranaesthetic.info Epidurals for pain relief after surgery Epidurals for pain relief after surgery What are the benefits? Your epidural
If your epidural is working properly, you will have better pain relief than other methods, particularly when you move. What will I feel?
● There may be reduced complications of major surgery, e.g.
nausea/vomiting, leg/lung blood clots, chest infections,
● The local anaesthetic stings briefly, but usually allows an
blood transfusions, delayed bowel function.
● There may be quicker return to eating, drinking and
● It is common to feel slight discomfort in your back as the
full movement, possibly with a shorter stay in hospital
compared to other methods of pain relief.
● Occasionally, an electric shock-like sensation or pain occurs
during needle or catheter insertion. If this happens, you
How do the nurses look after me on the ward
must tell your anaesthetist immediately.
with an epidural?
● A sensation of warmth and numbness gradually develops,
● At regular intervals, the nurses will take your pulse and
like the sensation after a dental anaesthetic injection.
blood pressure and ask you about your pain and how you
You may still be able to feel touch, pressure and
● They may adjust the epidural pump and treat side effects.
● Your legs feel heavy and become increasingly difficult to
● They will check that the pump is functioning correctly.
They will encourage you to move, eat and drink, according
● You may only notice these effects for the first time when
you recover consciousness after the operation, particularly if your epidural was put in when you were anaesthetised.
● The Pain Relief Team doctors and nurses may also visit
you, to check your epidural is working properly. epidural
Overall, most people do not find these sensations to be
epidural When will the epidural be stopped?
● The degree of numbness and weakness gradually
decreases over the first day after the operation.
The epidural will be stopped when you no longer require it
● The amount of pain relieving drug being given by the
epidural pump will be gradually reduced. www.youranaesthetic.info www.youranaesthetic.info Epidurals for pain relief after surgery Epidurals for pain relief after surgery
● A few hours after the pump is stopped, the epidural
catheter will be removed, as long as you are still
Side effects and complications
● All the side effects and complications described can occur
● The epidural catheter will be removed if it is not working
properly. It may be possible to insert another epidural catheter if necessary.
● Side effects are secondary effects of a treatment. They
occur commonly and may be unavoidable. Although they
Can anyone have an epidural?
may be unpleasant (for example, feeling sick), they are not usually dangerous. Complications are unwanted and
No. An epidural may not always be possible if the risk of
unexpected events that are known to occur occasionally
due to a treatment. Serious complications are rare or very
● you are taking blood thinning drugs, such as warfarin
● Permanent nerve damage is a very rare serious
complication of having an epidural. It can also happen if
● you have a blood clotting abnormality
you do not have an epidural. You can read more about
● you have an allergy to local anaesthetics
this in the risk articles on www.youranaesthetic.info.
● you have severe arthritis or deformity of the spine
● The risk of complications should be balanced against the
● you have an infection in your back.
benefits and compared with alternative methods of pain relief. Your anaesthetist can help you do this. People vary in how they interpret words and numbers. epidural
Very common Common Uncommon Rare Very rare
1 in 10 1 in 100 1 in 1000 1 in 10,000 1 in 100,000
www.youranaesthetic.info www.youranaesthetic.info Epidurals for pain relief after surgery Epidurals for pain relief after surgery Very common or common side effects and Inadequate pain relief. It may be impossible to place the epidural catheter, the local anaesthetic may not spread complications
adequately to cover the whole surgical area, or the catheter
Inability to pass urine. The epidural affects the nerves
can fall out. Epidurals can provide better pain relief than
that supply the bladder, so a catheter (tube) will usually
other techniques. Other methods of pain relief are available if
be inserted to drain the urine away. A catheter is often
necessary after major surgery even if you do not have
Headaches. Minor headaches are common after surgery,
an epidural, to keep a close check on the rate of urine
production. If you have a working epidural, you cannot feel the catheter, which will normally be left in for a few days.
Occasionally a severe headache occurs after an epidural
Bladder function returns to normal after the epidural wears off.
because the lining of the fluid filled space surrounding the spinal cord has been inadvertently punctured (a ‘dural tap’).
Low blood pressure. The local anaesthetic affects the
The fluid leaks out and causes low pressure in the brain,
nerves going to your blood vessels, so blood pressure always
particularly when you sit up. If this happens, it may be
drops a little. Fluids and/or drugs can be put into your drip
necessary to inject a small amount of your own blood into
to treat this. Low blood pressure is common after surgery,
your epidural space. This is called an ‘epidural blood patch’.
The blood clots and plugs the hole in the epidural lining. This
complications Itching. This can occur as a side effect of pain-relieving
will cure the headache in the majority of cases. For more
drugs that may be mixed with the local anaesthetic in your
information please see ‘Headache after an epidural or spinal
epidural. It can be treated with anti-allergy drugs. Feeling sick and vomiting. These can be treated with anti-sickness drugs. These problems are less frequent with an Uncommon complications
epidural than with most other methods of pain relief. Slow breathing. Some drugs used in the epidural can Backache. This is common after surgery whether you have
cause slow breathing and/or drowsiness requiring treatment.
an epidural or not. It is not related to having an epidural. It
Catheter infection. The epidural catheter can become
may be caused by lying on a firm flat operating table.
infected and may have to be removed. Antibiotics may be necessary. It is very rare for the infection to spread any
further than the insertion site in the skin. www.youranaesthetic.info www.youranaesthetic.info Epidurals for pain relief after surgery Epidurals for pain relief after surgery Rare or very rare complications Other complications, such as convulsions (fits), breathing Frequently asked questions
difficulty and damage to nerves are rare. Permanent disabling nerve damage, epidural abscess (infection), epidural
What if I decide not to have an epidural?
haematoma (blood clot) and cardiac arrest (stopping of the
It is your choice. You do not have to have an epidural.
● There are several alternative methods of pain relief with
In comparison, you are more likely to die from an accident
morphine that work well. This includes injections given by
on the roads or in your own home every year than suffer
the nurses or you may be offered a machine which allows
permanent damage from an epidural. Detailed information
you to control your pain relief yourself (Patient Controlled
about these risks is available from www.youranaesthetic. info under the section ‘Risks associated with having an anaesthetic’. These risks can be discussed further with
● There are other ways in which local anaesthetics can be
your anaesthetist who can take into account your personal
● You may be able to take pain relieving drugs by mouth.
● Every effort will always be made to ensure your comfort. questions complications How do I ask further questions?
● Ask the nursing staff or your anaesthetist.
● Most hospitals have a team of nurses and anaesthetists
who specialise in pain relief after surgery. You can ask to see a member of the pain team at any time. They may have leaflets available about pain relief. There is also more
information about epidurals on the website: www.youranaesthetic.info. Frequently www.youranaesthetic.info www.youranaesthetic.info Epidurals for pain relief after surgery Epidurals for pain relief after surgery Useful organisations The Royal College of Anaesthetists Churchill House
This organisation is responsible for standards in anaesthesia, critical
care and pain management throughout the UK. The Association of Anaesthetists of Great Britain and Ireland 21 Portland Place
This organisation works to promote the development of
anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland. organisations organisations The Royal College of Anaesthetists (RCoA) and The Association of Anaesthetists of Great Britain and Ireland (AAGBI) The RCoA and AAGBI agree to the copying of this document for the purpose of producing local leaflets in the United Kingdom and Ireland. Please quote where you have taken the information from. The Patient Information Unit must agree to any changes if the AAGBI and RCoA crests are to be kept. www.youranaesthetic.info www.youranaesthetic.info
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