What is it?
An epidural is used to give pain relief to children when they have an operation. It gives medicine continuously (an infusion) through a very small tube that goes into the child’s back. This tube delivers the medicine to the space that surrounds the spinal cord (epidural space) and numbs the nerves that travel from different parts of the body to the spinal cord and on to the brain.
An epidural is inserted by an experienced anaesthetist when the child is asleep under general anaesthetic. The small tube is called a catheter and is held in place with a sticky plastic dressing and glue.
How does it work?
Nerves send pain messages to the brain via the spinal cord. The medicine used in an epidural infusion temporarily blocks these messages before they get to the spinal cord and so reduces any pain felt.
The medicine given is a local anaesthetic and is often mixed with another medicine that helps to reduce pain. The medicines are delivered continuously using a pump to ensure good pain relief even if your child is sleeping.
When is an epidural used?
Epidurals are usually used to give pain relief after operations that are expected to be quite painful. They can also be very useful if a child is unlikely to be able to take medicines by mouth for a few days.
Most of the epidurals in this hospital are used for major orthopaedic surgery to the pelvis (hips) and legs, thoracic (chest) surgery or abdominal (tummy) surgery.
How long will the epidural stay in?
Most epidurals stay in for around 3 days.
Before stopping the epidural the team will make sure that other pain relief has been given and that the child is able to take the medicines to make sure they are comfortable.
The tube will be removed when the epidural is no longer required. This is not painful. Other pain medicines will given regularly after the epidural tube is removed.
Can everyone have an epidural?
Epidurals are not suitable for everyone and a child might have certain conditions that mean they are at higher risk of complications. This may mean that the risks outweigh the benefits and in these situations your anaesthetist may recommend an alternative pain management plan.
The following are reasons that may mean that an epidural is not suitable:
- Blood clotting problems
- Taking medicines that thin the blood (for example, aspirin, warfarin)
- Spinal problems
- Broken or infected skin on the back
- Reduced immune system
- Allergy to the medications used in an epidural
What are the side effects?
Unwanted effects may occur but they can usually be managed well. Children are monitored by the nursing staff for any problems that may arise.
Itchy and sickness
Sometimes the medicine used in the epidural can make children feel sick or itchy. Medicines will be prescribed to help and if necessary, the epidural medicine will be changed.
Difficulty passing urine
Some children find it difficult to pass urine (wee) when they have an epidural, as the epidural medicines also block the nerves to the bladder.
For this reason, a small tube called a urinary catheter can be inserted into their bladder during the operation that stays in whilst the epidural is being used.
Heavy, numb and wobbly legs
While the epidural medicine is being given it is common to have heavy, numb or wobbly legs. Most children can still manage to move around the bed a little, but the nurses will help them to move positions regularly.
Sometimes if the legs are very difficult to move, the amount of epidural medicine will need to be reduced, whilst still keeping the child comfortable.
Sometimes the pain medicine that is given with the local anaesthetic in the epidural can make children feel drowsy. This is not usually a big problem, but if it is, the epidural medicine will be changed.
Inadequate pain relief
Occasionally, the epidural does not give enough pain relief. There are often approaches that can be tried to improve it, which are usually successful. Very occasionally, it is not possible to make it the epidural work well enough and then other pain relief will be given.
From time to time there can be difficulty inserting the epidural catheter effectively or safely. If this is the case, other pain medicines will be started in theatre and continued after the operation.
The epidural medicine can leak around the insertion site. This is not usually a problem so long as enough medicine is getting to the nerves to maintain comfort. Sometimes the dressing may need to be changed if it becomes too wet.
Could there be any complications?
Complications can occur occasionally but are thankfully rare. They can include:
- Infections at the site of insertion and closer to the epidural nerves and spinal cord.
Infection in the epidural space is very rare (1 in 100,000) but potentially serious. Treatment with antibiotics would be needed to try to prevent nerve damage. To avoid this, epidurals are inserted in a sterile manner and kept clean under a dressing.
- Nerve damage by injury to the nerve whilst the epidural is being inserted
- Bleeding causing a clot that presses on the spinal cord causing nerve damage.
- Severe headache
What if I decide not to have an epidural?
The decision to have an epidural should be made after having a discussion with the anaesthetist.
There are alternative methods available that may be suitable, such as local anaesthetic nerve blocks or morphine infusions. These can provide effective pain relief after surgery but may have unwanted side effects, such as drowsiness and sickness.
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