We spoke to Professor Sibel Temür of Yeditepe University Hospital’s Department of Anesthesiology and Reanimation about epidural anesthesiology- popularly known simply as “epidurals”. Here, Professor Temür shares her background of knowledge and experience in the field to give Reference readers all you need to know about a subject of interest not only expectant mothers, but also many patient awaiting surgery.
We have all heard about “epidurals”, but apart from an association with childbirth, we don’t really know much about what they really are..
Yes, epidural anesthesia is widely talked about but its field of application is not limited to childbirth. Basically, it is a special kind of regional anesthesia in which anesthetic is injected into the epidural space of the spinal cord. This blocks transmission of signals through nerve fibers in or near the spinal cord. Regional anesthesia differs from general anesthesia in that the patient remains awake and aware of what is going around them. You mentioned childbirth, and this is a major field of application because epidural anesthesia allows pain free surgery while the mother remains conscious; she can see and hear her baby at the moment of birth.
So what are the other areas of application?
Apart from controlling pain during childbirth and cesarean surgery, epidural anesthesia is used in leg and foot surgery, hip replacement surgery, hernia repair, knee surgery, and in the relief of post-op pain.
Returning to childbirth and cesarean births, you mentioned the mother remaining awake and aware. Are there any other advantages?
Pain causes a stress reaction in the body, with the secretion of hormones such as adrenalin and noradrenalin. These hormones in turn cause a reaction during surgery, including increased blood pressure and more rapid heartbeat rates. During labor, they can have a negative impact on the baby.
Since epidural anesthesia only numbs the pain nerves, it achieves total pain control. The patient may not feel any pain at all after the procedure, whereas in general anesthesia post-op pain relief medication can cause drowsiness and dizziness. And while they enjoy the elimination of pain, epidural anesthesia patients can move around and play an active role in the childbirth process including the final stage of pushing the newborn into the world.
The chief advantage of epidural anesthesia in cesarean surgery is that it allow the mother, who remains conscious, to feel the birth of her child, hear its first cries and share the joys of childbirth with others.
A number of studies have shown that epidural anesthesia also serves to reduce the incidence of post-op bowel movement reduction (paralytic ileus) and deep vein thrombosis.
And how is the epidural anesthetic administered?
The patient is seated or lies on their side, with their head forward, knees bent and back arched as far as possible. An antiseptic solution is wiped on the patient’s lower back region and covered in sterile surgical cloth. The region where the injection is to be given is first numbed with a fine needle. A slightly thicker needle is then used to administer the anesthetic into the epidural space and a thin plastic catheter is fixed in place. The needle is removed and the catheter is fixed in place with a transdermal patch. This facilitates the administration of anesthetic as and when required to achieve long term pain relief during the procedure.
How does an epidural actually work?
Every organ in the body has structures called pain receptors. These pain receptors create the sensation of pain by transmitting pain stimuli with the help of nerve fibers first to the spinal cord then to the brain’s pain centers. Epidural anesthetic reaches the pain stimuli in the spinal cord, temporarily numbing the fibers that transmit signals further up the body and eradicating the sensation of pain. Used in appropriate dosages, local anesthetic does not affect the nerve fibers that facilitate the working of the muscles. This allows the patient to maintain normal movement and avoids any negative impact on the childbirth process.
The patient may have a sensation of cold when the medication is administered, and needs to wait 20-25 minutes for the medication to take full effect. The degree of drowsiness depends on the type and dosage of the anesthetic. To prevent post-op pain, a pump is placed on the tip of the catheter and local anesthetic continues to be administered for a period of 24 to 48 hours.
Are there any risks?
Epidural anesthesia is highly effective in eradicating pain and has a low risk of side effects. However, it is important that it is administered and overseen by experienced anesthetists specifically trained in the field.
Like any medical procedure, there are possible side effects including reduced blood pressure, perforation of the spinal cord membrane, an inability to urinate, lower back pain, temporary neurologic problems, hematoma, a fall in temperature, and technical or anatomical issues. But as long as the epidural is being handled by an experienced team in a well-equipped facility, the risk factors are minimal.
Are any patients not able to undergo epidural anesthesia?
Yes, some patients should not undergo the procedure, in particular those who are susceptible to excessive bleeding, have low blood pressure or allergies to the anesthetic in question, have an infection in the injection region, are suspected of having a neurologic condition, those with blood clotting disorders, using blood thinning
medications, and of course those who have not given their consent to the procedure.
And what of Yeditepe University Hospital? Why should an international patient choose your Department?
That’s an interesting question! I mentioned that the procedure-and indeed any medical procedureshould only ever be considered when it is conducted by competent, trained experts in a certified facility. Our doctors have an incredible range of experience not only in Turkey but in Europe, the States and elsewhere, and all our departments are internationally certified and monitored for quality as well as being equipped with the most advanced equipment and technology.