Epidural: What It Is, Procedure, Risks & Side Effects (2024)

What is an epidural?

An epidural is a procedure that involves injecting a medication — either an anesthetic or a steroid — into the space around your spinal nerves known as the epidural space. The goal of an epidural procedure is to provide pain relief (analgesia) or a complete lack of feeling (anesthesia) for one region of your body, such as your legs or belly.

An epidural is commonly called the following terms:

• Epidural anesthesia.
• Epidural block.
• Epidural steroid injection (ESI).
• Regional anesthesia.
• Neuraxial anesthesia.

How does an epidural work?

An epidural anesthesia injection works by injecting an anesthetic into the epidural space around your spine so that it can stop pain signals from traveling from your spine to your brain. The epidural space is filled with fluid and surrounds your spinal cord. Think of it as a liquid sleeve around your spinal cord.

Your spinal cord acts like a highway that connects the nerves located all over your body to your brain. When you get injured, for example, the nerve in that area of your body sends a pain signal that travels through your spinal cord to your brain and back. An epidural anesthetic temporarily numbs the spinal nerves, which then blocks pain signals in a certain region of your body depending on where along your spine your provider injected the epidural.

Epidural anesthesia can provide temporary pain relief or a temporary total lack of feeling. The following factors contribute to how much feeling you temporarily lose from an epidural:

• The type of anesthetic drug your provider uses.
• The concentration of the drug (how strong it is).
• The dosage of the drug.

An epidural steroid injection (ESI) works slightly differently and is used for chronic pain management. Instead of anesthetic medication, your provider injects a steroid or corticosteroid medication into the epidural space around your spine. Instead of blocking pain or feeling in a region of your body, the steroid coats the irritated nerve(s) that are causing you pain and works to reduce swelling. The steroid allows the nerve(s) time to heal. Epidural steroid injections can lead to temporary, long-term or permanent pain relief.

Who performs an epidural?

An anesthesiologist or certified registered nurse anesthetist usually performs an epidural procedure. Anesthesiologists have special training in the field of anesthesiology, which is a medical specialty that involves the care of people before, during and after their surgery or procedure. Anesthesiology covers anesthesia, pain medicine, intensive care medicine and critical emergency medicine.

Healthcare providers of other specialties, such as neurology, may also perform an epidural. Again, they’re specially trained to properly and safely perform an epidural procedure.

For epidural procedures that use a catheter, a supporting healthcare provider is usually present to help as needed.

What’s the difference between epidural analgesia and epidural anesthesia?

Analgesia is pain relief without losing consciousness (going to sleep) and without complete loss of feeling or movement. Anesthesiologists use epidural analgesia for people who are in labor and are delivering a baby. They inject the epidural into your lower back to provide pain relief for the lower part of your body due to contractions and childbirth.

Anesthesia is the loss of physical sensation with or without loss of consciousness. Epidural anesthesia itself won’t cause a loss of consciousness, but if you’re having a certain kind of surgery, your anesthesiologist may give you epidural anesthesia so you don’t feel any pain or don’t move during the surgery and a different medication to make you go to sleep (lose consciousness).

What are epidurals used for?

Your healthcare provider may recommend an epidural procedure for the following situations:

• To provide pain relief (analgesia) for labor and childbirth.
• To provide anesthesia for certain surgeries as an alternative to general anesthesia.
• To provide pain relief after certain surgeries.
• To manage certain causes of back pain and other forms of chronic pain (through epidural steroid injections).

What are the different kinds of epidurals?

There are different variations of epidurals based on certain factors. This section will explain different kinds of epidurals grouped into the following categories:

• How the medication is delivered.
• Labor and childbirth epidurals.
• Epidural steroid injections (ESI).

Epidural medication delivery options

There are a few ways your healthcare provider can deliver medication with an epidural, including:

• Single-injection epidural: This type of epidural involves one injection of a medication (an anesthetic or a steroid) into the epidural space around your spine. If you get a single injection of an anesthesia epidural, the feeling in your affected area usually returns within a few hours. A single injection anesthesia epidural is for short-term pain relief. Most epidural steroid injections are single injections.
• Epidural with a catheter: Most epidural procedures involve the use of a catheter in your epidural space so that your healthcare provider can give you a continuous flow of anesthetic medication, multiple separate doses or both. A catheter is a small, flexible tube that’s inserted through a narrow opening into a body cavity. In this case, your provider places a catheter that opens into the epidural space in your spinal area. This way, your provider can administer more than just one injection of medication. Providers usually recommend this type of epidural for longer operations, for providing pain relief over several days and for labor and childbirth.
• Epidural with patient-controlled analgesia (PCA): For recovery from certain kinds of surgery, your healthcare provider may allow you to control the amount of pain relief you’re receiving through your epidural catheter. This is called patient-controlled analgesia (PCA). Your healthcare provider sets controls on the PCA pump, which are programmed for the pain-relieving drug your provider orders based on your age, weight and the type of surgery you had. The PCA pump is safe to use because you receive medication by pressing a button when you feel pain, but the pump won’t give you the medication if it’s not time to receive another dose yet.

Labor and delivery epidurals

There are two general kinds of epidurals that you may choose during labor and childbirth. These include:

• Epidural with a catheter: Your provider will administer medicine through a catheter in your lower back that they insert with an epidural injection. The catheter remains in your epidural space so that your provider can give you more medication if needed.
• Combined spinal-epidural (CSE): A CSE is a combination of two injections: a spinal injection (spinal block) and an epidural. A CSE provides pain relief much faster than just an epidural. Because it involves a lower dose of medication, you’ll have a bit more feeling in your lower half. This allows you to move around more easily and change positions. This type of epidural is often called a “walking” epidural, but most people aren’t able to fully walk with this kind of epidural.

Epidural steroid injections (ESI)

An epidural steroid injection (ESI) involves an injection of a steroid or corticosteroid into your epidural space. It can help relieve neck, arm, back and leg pain caused by inflamed spinal nerves due to certain conditions or injuries. Pain relief from an ESI may last for several days or even years.

People who have pain in their neck, arm, lower back or leg due to the following conditions may benefit from epidural steroid injections:

• Spinal stenosis.
• Spondylolisthesis.
• Herniated disk (slipped, ruptured or bulging disk).
• Degenerative disk disease.
• Sciatica.

How common are epidurals?

Epidurals are a common procedure. An epidural is the most popular method of pain relief during labor and childbirth. More than 50% of people who give birth at a hospital choose to receive epidural analgesia. Epidural steroid injections (ESI) are one of the most commonly performed pain relief procedures.

Who shouldn’t get an epidural?

Due to certain medical conditions, not everyone can have an epidural. Because of this, it’s important to talk to your healthcare provider about your medical history and any questions you have. If you have any of the following conditions, you may not be able to get an epidural:

• Anesthetic drug allergies.
• Blood clotting issues.
• An infection.
• Poorly managed diabetes (for epidural steroid injections).

If you’re unable to undergo an epidural procedure, your healthcare provider may recommend another type of pain relief or anesthesia for you, or they may have you wait until a better time to have your surgery, if possible.