Epidural Anesthesia
In the arsenal of modern anaesthesiologist there are several kinds of pain of childbirth. But most often it is applied epidural anesthesia. This choice is justified. Spent technique, modern tools, local application of new substances and pain of antimicrobial drugs for the treatment of skin puncture site will make this type of pain is widely available and fairly safe. In developed countries epidural anaesthesia is used as the primary method of pain as when natural childbirth, and in the caesarean section.
Compared with other methods of pain epidural anesthesia has a number of advantages. First, it is an effective method of painkillers, which remains in the minds of births. Secondly, epidural anaesthesia has a relaxing effect on the cervix. And thirdly, if rassoglasovannoy generic activities, in which the uterine muscle fibers are not reduced simultaneously, it is able to provide the coordinating influence. Finally, epidural anaesthesia, as evidenced by practical observation, has minimal impact on the child.
The mechanism of pain
To understand how the epidural anesthesia, need some background in anatomy.
As is known, the spinal cord is located in the vertebral canal and surrounded by several shells. From the brain to other organs stretch nerves - the so-called roots in the spinal cord. Front roots "responsible" for the reduction of skeletal muscles, ie for the movement, and rear - for sensitivity, including pain. Nerve-roots go through a hard shell in epidural space brain, where they are surrounded on all sides by fat tissue. It is in this space and introduces the pain substance. Why same procedure, the impact on the department of central nervous system - the spinal cord, relatively safe?
1. Needle anaesthesiologist does not reach the spinal cord and, of course, does not penetrate it.
2. Substance is brought pain to sensitive rear roots, and if affects the front propulsion roots, it is usually slightly (from the woman to give birth normally retained the ability to move independently, although sometimes it may feel numbness legs - it depends on the drug used).
3. Pain substance imposed epidural space, enters the blood very slowly. Liver manages to clear the medicine before its concentration in the blood become sensitive to the child.
How to spend epidural anaesthesia
Woman sets or falls on the side dish back (in this situation, which is sometimes compared to a posture wrathful cats, increasing the distance between the lumbar vertebrae spinalis processes - these sprouts were at the center back, and you can feel them from themselves; thinness of people they have clearly). Before executing the puncture made antibacterial treatment of skin and its pain. Then anaesthesiologist introduces a special needle between neighbouring spinalis processes at the level of lumbar vertebrae. To verify that the needle really hit the epidural space, a doctor conducts a special test. Then, inside a thin catheter needle miss up to the level of the spinal cord roots, which are responsible for the pain sensitivity of the pelvis and abdomen. Since then remove the needle, catheter perpetuated on the back with the help of court plaster and impose on it a special zamokperehodnik for the introduction of drugs. Woman falls on the back. In order to check if a catheter and whether a woman allergic reaction to medication, introducing a trial dose of anaesthetic. After that introduces the main dose of medication. In the future introduction of anaesthetic drugs produced portions - as the emergence of pain or 30 minute intervals. Every time before the introduction of anaesthetic births inspects obstetrician.
After a few minutes after the introduction of drug births begins to feel the warmth and weakness in legs, cramps become painless. If the uterus declined ineffective, since the beginning of very often sets the normal full-fledged fight, is accelerating the process of disclosure of the cervix. Increased blood pressure against the backdrop of epidural anesthesia is stabilized by withdrawing spasm of small vessels, so this method is recommended that patients arterial hypertension, coronary disease and some types of heart disease, renal failure. When the normal level of blood pressure to prevent its possible reduction, with births put dropper harmless for baby solutions, increases the volume of blood. Before the end of the first period childbirth pain stops: the restoration of normal sensitivity helps develop potug. In some countries made anesthesia first and second periods of births, but in Russia anaesthetize only taken the first period. The point is that under the influence of anaesthetic second term births often longer, which often leads to the need for surgical intervention. The seams or gaps in the section of the perineum imposed after the introduction of new portions of anaesthetic. Within two hours after giving birth, the young mum is under the supervision of Anesthesiology and obstetricians. Before the transfer of women in post-office catheter are removed.
Typically, epidural anaesthesia will be held with a planned caesarean section. Note that epidural anaesthesia, in which the births of their choice is in full consciousness, hold only until the emergence of baby. When doctors sew cut, a woman sleeping-pills are introducing products.
If a woman is afraid of the operation, she performed epidural anesthesia, after which it enters sleeping-pills before the start of the operation. It does not require artificial lung ventilation (as in an anaesthetic), and therefore reduces the risk of complications in the lungs. Therefore, this method of pain are encouraged smokers, patients with chronic bronchitis, bronchial asthma. After graduating from operations in the epidural space solution introduces drugs. As a result, the woman does not feel pain at the site of the section six - ten o'clock.
At the time of epidural anesthesia, as well as childbirth through the night
How long does it take before an epidural starts to work?
There’s a really wide variation of timing here — it all depends on the specific combination of your hospital’s schedule, your anesthesiologist’s availability, and your own reaction to the medication.
In general, expect to wait about…
1) 10-60 minutes: The amount of time it takes the anesthesiologist to get to your room.
2) 10-30 minutes: How long it takes to have the epidural administered.
3) 10-30 minutes: How long until you should feel the effect of the epidural.
Another factor to take into account: In order to not slow down or stall your labor, you can usually only get an epidural when your cervix is dilated to at least 4 to 5cm — and after you’ve reached full dilation (10cm), it’s too late.
While epidurals are there to cut down on the pain, they’re not exactly fun to get. To start, the anesthesiologist will wash your back with a sterile solution, which feels cold, and give you a small local anesthetic before the big needle is used. Then you have to hunch over to open the spaces between your vertebrae — and that’s a position that can be really tough to maintain through the contractions. But maintain it you must, as you need to be perfectly still while the doctor is placing the needle and the catheter near the spinal cord.
To add insult to injury, if you haven’t finished all your hospital paperwork ahead of time, you may be required to sign a consent form before the procedure can begin. (Yeah, try reading the fine print while you struggle through a contraction. Lesson: Make sure all your paperwork is complete no later than week 34!)
While epidurals work well for most women (there’s a reason people name their kid after the anesthesiologist!) this method of labor pain relief can also be imperfect. For instance, sometimes the medication only affects one side of the body (at least initially).
One of the most common complaints is that you have to stay in bed — no more walking around, trips to the bathroom or other things (like maybe cartwheels or forming a conga line with the tens of people who seem to be in your room) to get labor moving along more quickly. Also, you will almost always be given pitocin, usually via IV (the “pit drip”) after an epidural to help force your labor into a higher gear.
Finally, don’t take it for granted that your hospital always has someone on call to give you an epidural! Especially if you live in a somewhat rural area, it ain’t necessarily so. woman must comply with bed rest. Modern drugs used for anesthesia, usually do not cause allergic reactions, have a strong sedative effect, virtually harmless. When childbirth through natural ways to use generic drugs short time action, with caesarean section - long. The main medicines are briefly acting lidocaine (up to 1 hour) and long-acting bupivakain (up to 3 hours).Side effects and complications
The holding of epidural anesthesia is unacceptable when unconscious, eclampsia, violating coagulability blood purulent skin lesions of the back, generally infecting blood (sepsis), impairment of brain and spinal cord, spine, high intracranial pressure, migraines, allergic reactions to anaesthetics used. Relative contraindications are the curvature of the spine and nervous system diseases. In these cases, the doctor decides to anesthesia, based on the specific situation.
Sometimes, during and after the epidural anesthesia complications may arise:
1. Headache. It usually appears at first to third day after birth as a result of brain damage hard shell and the expiration of cerebrospinal fluid in the epidural space. The pain may last for 1 - 2 weeks, sometimes delayed up to 6 weeks. Treatment usually includes bed rest, painkillers and sedatives means caffeine.
2. If the sterility of the possible manipulation inflammation in the place of injections, epidural space, the envelopes of spinal and brain.
3. When you enter the main dose of the drug instead of epidural space in the spinal canal patient may temporarily lose the ability to move. This state is continuing only for the duration of drug action.
4. When you enter the main dose of anaesthetic in the blood vessels can occur sharp drop in blood pressure and disruption of the heart.
5. Symptoms of allergic reactions to the medication used.
When conducting anesthesia complications are rare. It must be said that the influence of special research epidural anesthesia for the child not conducted, but practical experience shows that the effect of epidural anesthesia for the baby is minimal. However, the development of complications, such as expressed by falling blood pressure, can disrupt the placental circulation. Finally want to say that generic pain - the feeling that allows a woman-oriented that it is happening, and act as necessary in this time of childbirth. It must be said that the threshold of sensitivity among different people different, respectively, and the process of giving birth, women feel in different ways. Regular moderate pain in childbirth does not require anesthesia (because you have no desire to use anaesthesia to reduce pain after heavy physical exertion). Fear of pain - the real psychological reason for the cycle in which pain breeds fear, fear and pain increases. This often led to violations of tribal activities. And only in cases where the pain is so strong that it overrides all other feelings, or when the use of anaesthesia necessarily (for example, when caesarean section), intervention by the anaesthetists really necessary.
Of the stories ...
On anesthetic childbirth people started to think very long. Epidural anaesthesia is a central neuraxial block technique with many applications. The epidural space was first described by Corning in 1901, and Fidel Pages first used epidural anaesthesia in humans in 1921. In 1945 Tuohy introduced the needle which is still most commonly used for epidural anaesthesia. Improvements in equipment, drugs and technique have made it a popular and versatile anaesthetic technique, with applications in surgery, obstetrics and pain control. Both single injection and catheter techniques can be used. Its versatility means it can be used as an anaesthetic, as an analgesic adjuvant to general anaesthesia, and for postoperative analgesia in procedures involving the lower limbs, perineum, pelvis, abdomen and thorax.
How long does it take before an epidural starts to work?
There’s a really wide variation of timing here — it all depends on the specific combination of your hospital’s schedule, your anesthesiologist’s availability, and your own reaction to the medication.
In general, expect to wait about…
1) 10-60 minutes: The amount of time it takes the anesthesiologist to get to your room.
2) 10-30 minutes: How long it takes to have the epidural administered.
3) 10-30 minutes: How long until you should feel the effect of the epidural.
Another factor to take into account: In order to not slow down or stall your labor, you can usually only get an epidural when your cervix is dilated to at least 4 to 5cm — and after you’ve reached full dilation (10cm), it’s too late.
While epidurals are there to cut down on the pain, they’re not exactly fun to get. To start, the anesthesiologist will wash your back with a sterile solution, which feels cold, and give you a small local anesthetic before the big needle is used. Then you have to hunch over to open the spaces between your vertebrae — and that’s a position that can be really tough to maintain through the contractions. But maintain it you must, as you need to be perfectly still while the doctor is placing the needle and the catheter near the spinal cord.
To add insult to injury, if you haven’t finished all your hospital paperwork ahead of time, you may be required to sign a consent form before the procedure can begin. (Yeah, try reading the fine print while you struggle through a contraction. Lesson: Make sure all your paperwork is complete no later than week 34!)
While epidurals work well for most women (there’s a reason people name their kid after the anesthesiologist!) this method of labor pain relief can also be imperfect. For instance, sometimes the medication only affects one side of the body (at least initially).
One of the most common complaints is that you have to stay in bed — no more walking around, trips to the bathroom or other things (like maybe cartwheels or forming a conga line with the tens of people who seem to be in your room) to get labor moving along more quickly. Also, you will almost always be given pitocin, usually via IV (the “pit drip”) after an epidural to help force your labor into a higher gear.
Finally, don’t take it for granted that your hospital always has someone on call to give you an epidural! Especially if you live in a somewhat rural area, it ain’t necessarily so.
