Epidural administration

Epidural administration is a form of pain relief. It involves inserting a needle or a small catheter into a space in the spine to gain access to the nerves located there to administer pain-relieving medications. The procedure for doing this is often referred to as simply an epidural. Epidurals can be used for short-term pain, such as during a surgical procedure, or for long-term or chronic pain. They are often used during surgery, during recovery from surgery or trauma, for cancer patients, and during labor. Epidurals are used because they provide excellent pain relief with a lower amount of medication. There are some risks associated with their use, however. These include the potential for damage to the spinal nerve and the possibility of causing dangerous paralysis by inadvertently numbing too much of the body, especially the lungs.

Background

The word epidural comes from the Latin epi, meaning “upon,” and dura, which is the thick membrane that protects the spinal cord and brain. The idea of using a device to place medication directly into the body dated back to the days of the ancient Romans, and early efforts were made in the 1400s toward creating one. However, the first practical syringes to inject medications beneath the skin were created independently by French physician Charles Gabriel Pravaz and Scottish physician Alexander Wood. Although they were not working together, the two men both created their devices in 1853. Wood developed his device for the administration of pain medications.

The first use of a needle to inject medication into the spine for pain relief occurred in 1885 when American neurologist James Leonard Corning administered an injection of cocaine to a volunteer. Spanish surgeon Fidel Pagés Mirave is credited with developing the technique for administering a single epidural injection for pain relief in 1921. Italian surgeon Achille M. Dogliotti developed a reliable method for determining where to place the needle in the spine to get the greatest benefits with the least risk in the 1930s.

By 1941, American anesthesiologists Robert Andrew Hingson and Waldo B. Edwards developed the additional technique of using the syringe to place a small tube called a catheter into the space in the spine. This provided access to administer multiple doses of the pain reliever without repeatedly puncturing the spinal area. The process was further refined by American surgeon James L. Southworth. The technique was first used during labor in 1942. The patient was a military wife who needed a Caesarean section, or surgical delivery of her baby, but she was not a candidate for other methods of anesthesia because of a preexisting health condition. An epidural with a catheter was used successfully; both mother and child survived.

Physicians worked throughout the twentieth century to improve and refine the technique. They experimented with new materials for catheters and found ways to overcome problems such as catheters that twisted or kinked. By the twenty-first century, epidural administration became a standard treatment for many types of pain.

Overview

Epidurals involve using a needle or a needle and catheter to insert medication directly into the space between the dura, or thick outer covering of the spinal cord, and the vertebrae, or bones of the spinal cord. This is called the epidural space. The area contains blood vessels and nerves. Placing the medication here allows the physician to target the nerves directly. Many other methods of pain relief flood the entire body with pain medication, which requires higher doses of medication to be effective and exposes other body systems to the drug.

A patient receiving an epidural will have an intravenous line inserted in the arm so that fluids can be administered. The patient will then either curl up on the left side while lying down or curl forward while sitting. This opens the spaces between the vertebrae and allows for the insertion of the needle. The area will be cleaned, and the person administering the epidural will identify the correct space to insert the needle. After a one-time injection, pressure and a small bandage will be applied to the area. If a catheter is needed to allow for more doses, the catheter will be slid into place, the needle will be withdrawn, and the catheter will be secured to the back with tape. Medication will then be added via the catheter as ordered by the physician.

An epidural can be administered in different parts of the spine, depending on what part of the body the physician is targeting. The physician can also choose to administer an analgesic or an anesthesia. Analgesics are medications used for pain management. A patient who is recovering from surgery or who is having a baby might receive an epidural analgesic. The effects of an epidural analgesic last a few hours. For patients who need long-term pain relief, such as those recovering from a serious injury or a cancer patient, long-term analgesic relief is often provided by inserting a catheter into the epidural space. This small, thin tube offers a way to add repeated doses of pain medication, often through the use of a small pump that delivers predetermined doses of medication at set times.

In other cases, epidurals are administered as a means of anesthesia. Anesthesia blocks pain but also affects the patient’s ability to move. It is used during surgical procedures, including the surgical delivery of babies. Epidural anesthesia involves larger doses of medication than analgesic epidurals but provides relief from the pain of procedures without requiring the patient to be unconscious. This is desirable for some surgeries and is often preferred by women in labor who need a Caesarian delivery but want to be awake for the birth of their baby.

Epidurals provide a good means to control pain for a variety of patients. They can be used with many types of pain relievers, including short-acting local analgesics such as lidocaine and mepivacaine and with longer-acting local analgesics such as ropivacaine and bupivacaine. Opioid pain medications such as morphine and fentanyl can also be administered via an epidural.

While they provide an excellent means of pain management for many patients, there are risks associated with epidural administration. There is a risk that the needle will enter the wrong part of the spine and potentially numb the wrong area of the body. Side effects from this could include difficulties breathing, problems with the heart, and the inability to move parts of the body. Many of these problems can be overcome by medical professionals. Some patients also experience a severe headache after receiving an epidural. This can be managed by injecting some of the patient’s own blood into the spine.

Bibliography

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“Epidural: Overview.” National Health Service, www.nhs.uk/conditions/epidural/. Accessed 2 Nov. 2018.

Sawhney, Mona. “Epidural Analgesic: What Nurses Need to Know.” Nursing, vol. 42, no. 8, Aug. 2012, pp. 36–41.

Toledano, Roulhac D., et al. “Epidural Catheter Design: History, Innovations, and Clinical Implications.” Anesthesiology, vol. 121, 2014, pp. 9–17.

“Upfront: The Birth of the Epidural.” Royal College of Midwives, 2014, www.rcm.org.uk/news-views-and-analysis/analysis/upfront-the-birth-of-the-epidural. Accessed 2 Nov. 2018.

“What Is an Epidural?” WebMD, www.webmd.com/back-pain/what-is-an-epidural#1. Accessed 2 Nov. 2018.

“What Is Epidural Anesthesia?” Miami Center of Excellence, www.miamiobgyns.com/blog/what-is-epidural-anesthesia-and-how-is-it-administered/. Accessed 2 Nov. 2018.