In patients hospitalized for certain medical procedures, different drugs are needed to be administered. Moreover, if the patient is lined up for surgery, there is also a need to give anesthesia before starting. All of these chemical compounds which are pumped into a patient’s body need a route to get in. Despite being the most preferred route, many drugs or other chemicals cannot be administered through the oral route. This hindrance forces the physician to use other ways to do the job. One such route is the epidural route which was initially infamous for the side effects associated with it. But are these side effects bad enough to avoid the epidural route? In this article, let us take a look at what sort of epidural side effects a patient can experience after going through the procedure.
What is an epidural?
The term epidural has been originated from the combination of two words: ‘epi’ meaning around or on and ‘dural’ which indicates the dura mater or dura membrane, a protective layer around the spinal cord (and brain). Hence, it is a location or space around the spinal nerves, between vertebrae L3 and L4 to be exact, which can be used to deliver drugs or anesthesia to the patients. It is most suitable in cases when other routes are either not suited for the procedure to be conducted or have already failed.
An injection is to be administered via the epidural route
Terms synonymous with epidural
Other terms used for the epidural process are:
- Epidural block
- Regional anesthesia
- Neuraxial anesthesia
Implications of epidural administration
Administration of a drug substance/anesthesia via the epidural route has several implications which include the following:
- Labor and childbirth: Epidural route is a preferred choice for the administration of anesthesia during the process of labor and childbirth to create numbness in the area below the waist. This reduces the strong sensation of pain to a mild pressure thus easing the delivery.
- Steroid administration: Epidural steroid injections, abbreviated as ESIs, are given to patients with a history of chronic pains. Moreover, this is also an effective therapy for relieving back pain caused due to multiple causes.
- Post-operative pain: Analgesics are also commonly administered via the epidural route in patients who have moderate to severe pain after a major surgical procedure.
Side effects associated with epidural administration
The epidural route has always haunted patients due to the huge number of side effects associated with it. However, in recent times, patients especially women have become more comfortable with the choice of this route during procedures. Although the side effects of the epidural route have not completely vanished, they have indeed reduced in incidence. Some of these side effects include:
- Back pain: Once the epidural route has been used, it is expected to feel soreness and pain for a few days. However, if the pain does not subside automatically, consult your physician.
- Numbness and tingling: Numbness in the body especially in the legs followed by tingling has to occur if the anesthesia is working properly. However, in some rare cases, this numbness and tingling can last longer than usual.
- Lightheadedness: A feeling of lightheadedness can be accompanied by an epidural injection which may persist for a few hours. The reason behind this is the decrease in the patient’s blood pressure.
- Headache: Although rarely, a headache can occur as an aftermath of the leaching of cerebrospinal fluid followed by an epidural injection.
Headache followed by epidural procedure
- Uncontrolled bladder and bowel activities: The patient may experience altered or rather uncontrollable bowel and bladder movements for a while after an epidural procedure. However, the problem is temporary and should be resolved soon. Until then, your physician will ask the nurse to insert a catheter for the management of the issue.
- Infections: The administration of drug substances or anesthesia via epidural route can result in the initiation of an infection in the spinal cord which can further progress to the brain and even bones. Meningitis is also a common occurrence as the microbes transferred to the cerebrospinal fluid via the needle can penetrate easily into the nearest target i.e. brain. Additionally, discitis (an inflammatory condition affecting the space between the vertebral disks), osteomyelitis (swelling of tissue associated with bones), and epidural abscess (an infection affecting the space between the lining of the brain and the skull bones) are also likely to occur.
- Hematoma formation: If, while giving an epidural injection, a blood vessel gets ruptured, the blood from it might start dripping resulting in the formation of clots of blood or hematomas.
- Seizures: In some cases, the pain-relieving medication being given via epidural route seeps into the veins thus causing a seizure.
- Hypersensitivity reaction: If the patient is sensitive to the drug substance being administered, there is a chance of a hypersensitivity reaction which can become life-threatening in some cases.
Back pain followed by epidural injection
Apart from these, the less common epidural side effects include:
- Nausea
- Vomiting
- Pyrexia
- Breathing difficulties
- Sepsis
Contraindications
If a patient has any of the following conditions, the use of an epidural route for any purpose is not recommended.
- An existing infection
- A history of allergic reactions to anesthetic substances
- Uncontrolled diabetes (especially for ESIs)
- A history of blood clotting issues
Conclusion
The epidural route is one of the widely used routes for the administration of drug substances, steroids, analgesics, as well as anesthetics. It is particularly advantageous in female patients in cases of labor and childbirth. However, like any other medical procedure, an epidural comes with its own list of side effects which range from milder ones to comparatively life-threatening occurrences. Although, if the epidural injection is injected with care from the hands of a properly trained healthcare professional, there is nothing to worry about.
PhD Scholar (Pharmaceutics), MPhil (Pharmaceutics), Pharm D, B. Sc.
Uzma Zafar is a dedicated and highly motivated pharmaceutical professional currently pursuing her PhD in Pharmaceutics at the Punjab University College of Pharmacy, University of the Punjab. With a comprehensive academic and research background, Uzma has consistently excelled in her studies, securing first division throughout her educational journey.
Uzma’s passion for the pharmaceutical field is evident from her active engagement during her Doctor of Pharmacy (Pharm.D) program, where she not only mastered industrial techniques and clinical case studies but also delved into marketing strategies and management skills.
