Introduction
An epidural is a procedure where anaesthetic is given through the lower back into a space around the spine. Epidurals are used for major surgery that involves the chest, abdomen, or lower limbs. They can also be used to manage pain after surgery. Anaesthetic is a mix of medicines that numbs the body so it does not feel pain. Anaesthetic is given by a specialist doctor called an anaesthetist.
Before the procedure
Your child's anaesthetist will give you information about the epidural, what it involves, the risks and side effects.
An epidural will only be used if your child's doctors think it is the best option for pain relief and recovery from surgery. Having an epidural can lower the risk of vomiting after surgery. It can also help your child get back to eating and drinking normally faster than other types of pain relief.
During the procedure
During the surgery, your child will be under a general anaesthetic. This means they will be asleep.
The anaesthetist will insert a thin tube called an epidural catheter into the lower back using a special needle. The tube will go into the space just outside the spinal cord. This is called the epidural space.
Once the epidural catheter is in place, the needle is removed. The epidural catheter is then covered with tape, and a plastic dressing is placed on your child's back.
Having an epidural means the lower half of your child's body has no feeling. Another thin tube, called a urinary catheter, will be inserted into your child's urethra and bladder to help them drain urine. The urinary catheter is left in while the epidural is in place.
After the procedure
The epidural will stay in place after the operation. It will be connected to a pump that continually gives a mixture of pain-relieving medicines to your child.
The mixture of medicine includes a local anaesthetic that numbs the nerves, along with pain relief.
The epidural should not be painful while in place, but it may feel strange when your child first starts moving around. Your child should not try to walk without help while the epidural is in. Ask a nurse if you need support moving your child from the bed to a comfortable chair.
If the epidural is working well, your child will feel no pain around the surgery area.
Let your child's doctor and nurses know immediately if they have any pain or other problems like:
- numbness
- skin that is cold to touch
- one or both legs feel 'heavy' or numb.
Management
Epidural side-effects
Epidurals work well and are safe for children of all ages. Your child's treatment team will check the epidural, equipment, and dose of pain medication to make sure everything is working well. They will also check your child's breathing, heart rate and movement every hour.
Epidurals can cause some manageable side effects, including:
- headaches
- itchy skin
- vomiting
- infection.
There is a small risk of severe allergic reactions to the drugs used and harm to the nerves in the spinal cord. These side effects are rare.
Talk to your child's doctor if you have any questions or concerns about the epidural and its side effects.
Epidural duration
The length of time the epidural stays in will depend on the type of surgery and the amount of pain your child is expected to have. The epidural is usually taken out after 3-5 days when the pain starts to settle, and your child gets back to eating and drinking normally.
The epidural is removed after a maximum of 5 days to prevent infection. It can be taken out earlier if it is not working properly and your child is still experiencing pain.
Epidural removal
Once the epidural is stopped, it can take up to 6 hours for the medication to wear off gradually and for the feeling to return to the lower body and legs.
While this happens, your child's doctor will give pain relief by mouth or through the IV cannula.
The tape on your child's back will be gently removed, and the epidural catheter is then pulled out slowly. This should not cause any pain.
Your child may also have their urinary catheter removed as they get feeling back in the lower half of their body and can start to use the toilet again.