Headaches after epidural anesthesia, so-called post-puncture headaches, are a phenomenon encountered by every third patient during whose operation this method of pain relief was used.
Epidural anesthesia is a method of pain relief known for its use during labor and caesarean sections. Now it is quite popular, and experts unanimously speak about the virtual absence of harm when using such anesthesia. But, nevertheless, epidural anesthesia also has a number of complications, one of which is headache.
The mechanism of pain in the head and neck after epidural anesthesia is directly related to the technology of its implementation, so let's first understand this aspect.
Epidural anesthesia is a method of pain relief in which medication enters the body through a pre-installed catheter and flows in a continuous stream. To insert a catheter, the doctor uses a special needle that is inserted into the epidural space. During the puncture, due to inaccuracy in the manipulation, an accidental puncture of the subarachnoid space may occur, resulting in an outpouring of cerebrospinal fluid (CSF). Cerebrospinal fluid plays a very important function:
- It is what protects the brain from external influences and damage, and acts as a shock absorber when the head moves.
- Regulates metabolic processes in the brain and spinal cord
- Regulates intracranial pressure
The lack of cerebrospinal fluid, in turn, provokes a drop in intracerebral pressure. This is the reason why you get a headache after an epidural. If after an epidural not only your head hurts, but also your neck, it means there has been a disruption in the functioning of the cervical canals.
As a matter of fact, the risk of developing severe headaches after epidural anesthesia is much less than after spinal anesthesia. If unpleasant symptoms appear, there is most likely a medical error.
What is epidural anesthesia?
When treating patients, various medications are prescribed. These include painkillers of varying degrees of action. Epidural anesthesia, or epidural, is one of the methods of pain relief in order to eliminate any sensitivity in the patient’s body below the waist. Despite the fact that this method has its obvious and undeniable advantages, some patients complain that their back hurts after epidural anesthesia. Accordingly, questions arise about why this happens, and what needs and can be done to make the discomfort go away faster?
Three myths associated with this type of anesthesia
The method is completely safe if the procedure is performed by an experienced anesthesiologist. But there are at least three myths among patients that are associated with this type of pain relief, and they need to be dispelled.
- Many people believe that after such anesthesia paralysis can occur. Undoubtedly, there is a possibility of such a turn of events, but it is extremely small. An experienced specialist will not make a fatal mistake that could lead to paralysis.
- The pain at the catheter insertion site will not go away. Yes, your back will hurt for the first time after such anesthesia. But it hurts for everyone, and soon the discomfort will disappear.
- They say that such anesthesia leads to the appearance of tumors. This is not true. The connection between this method of pain relief and the development of tumors has not been scientifically proven. The maximum that awaits the patient is a hematoma, which will resolve over time.
Epidural anesthesia is completely safe
When is it prescribed?
Before answering the question of what to do if your back hurts after epidural anesthesia, you need to understand what this procedure involves and when it is prescribed. Medications are administered by catheterization (through catheters into existing cavities in the human body) into the space of the spinal cord. The puncture site is also anesthetized so that the patient does not experience any pain when the painkiller is administered. The effect after the administration of medications occurs within 10–15 minutes. Most often, an epidural is prescribed to women in labor - during childbirth or when a caesarean section is scheduled. In such cases, it is important not to harm the fetus, and this method is safe for the baby. In addition to obstetrics, epidurals are prescribed in urology, gynecology, and during surgery in the abdominal cavity or on the pelvic organs.
Other methods of pain relief
There are a large number of anesthesia techniques, each of which has its own indications and contraindications. They differ in the degree of impact on the central nervous system and the area of application.
General
Anesthesia, or general anesthesia, is a technique that is widely used in surgery. It most effectively blocks the transmission of nerve impulses, but is accompanied by complete depression of the patient’s consciousness.
Spinal
The technique for performing this anesthesia is similar to the technique for performing an epidural block. However, the drug is injected deeper - into the subarachnoid space formed by the arachnoid membrane and the spinal cord. This makes it possible to more effectively reduce the passage of the nerve impulse, but the risk of complications when performing such a procedure is much higher.
Local infiltration
Local anesthesia is advisable when performing minor surgical interventions, for example, removing cellulitis and abscesses. The anesthetic is injected into the fatty tissue under the skin directly at the incision site.
Conductor
This anesthesia is a type of local anesthesia. Indications for the procedure are the same. The difference is that the medicine is injected into the area where the nerve passes, innervating the surgical site. Thanks to this, it is possible to temporarily stop the transmission of pain impulses through it.
Terminal
This technique involves blocking the transmission of pain impulses at the level of nerve endings. It is most often used for minor interventions on the mucous membranes. To numb them, the anesthetic is simply sprayed onto the surface.
Why does my back hurt after epidural anesthesia?
When the medications stop working, the patient begins a recovery period, which is accompanied by various sensations. Sometimes patients experience back pain after an epidural, and how long it hurts and whether any treatment is needed depends on the type and complexity of the surgery and the resulting complications. The occurrence of pain of varying degrees and localization occurs for various reasons. How quickly does a patient recover after receiving an epidural, and what can happen? Timing and response are individual indicators. The causes of pain are also varied.
Infection
Infection develops where the needle was inserted, for example because mistakes were made during disinfection. In some cases, a problem arises if the catheter is left in the patient's body when additional and longer-term pain relief is required.
Intervertebral hernia
If the pain persists for several months or longer, then most likely the patient has an intervertebral hernia. It is not a contraindication to an epidural, but may be an individual feature that should be taken into account when prescribing this method of pain relief; in any case, careful monitoring of the patient’s condition is required.
Medical errors
Back pain after epidural anesthesia may also have a cause such as medical error. This happens if the doctor touches a bunch of veins when installing a catheter and inserting a needle. This is rare, but patients who take medications to improve blood circulation are at risk (this should be noted in the medical history). Also, when carrying out the necessary manipulations (in the absence of sufficient experience on the part of the doctor), the hernia or ligaments, as well as the roots of nerve fibers, may be damaged. Your back may also hurt after epidural anesthesia for a caesarean section. This happens because the mother’s center of gravity moves, and the body needs time to adjust to a new state and cope with the stress experienced.
Indications for use
Epidural anesthesia requires high professionalism of the anesthesiologist, because any incorrect action is fraught with serious consequences for the entire body. This is one of the good reasons why you need to carefully weigh all the risks and the need for such a procedure.
The most common cases of using this method of pain relief in obstetrics are:
- premature onset of labor;
- caesarean section according to indications, which was prescribed as planned;
- high uterine tone;
- low pain threshold in women;
- multiple pregnancy;
- protracted labor process, unforeseen difficulties during childbirth;
- high blood pressure;
- high concentration of protein in the urine.
There is no need to be afraid for the fetus, because epidural anesthesia does not have a negative effect on the intrauterine body. During the process of childbirth, the woman feels well, without feeling pain, but at the same time, movements at this moment are not limited, the patient can move freely.
Elimination of pain after the procedure
Normally, the body and body sensitivity are restored a short time after the procedure. If this does not happen, it is recommended to consult a neurologist
who will find out why your back hurts after epidural anesthesia and what to do to relieve the discomfort.
Painkillers
During normal recovery, no painkillers or other medications are required. But if the intensity of the pain is strong enough and lasts a long time, only a doctor can help you choose the right painkillers depending on what the epidural was needed for and why the pain occurred.
Seeing a doctor
If there is inflammation or irritation, then treatment will require taking antibiotics prescribed by a doctor, and in case of an abscess and serious suppuration, treatment by a surgeon is necessary. The doctor can also give valuable recommendations on nutrition - especially for overweight patients or women after childbirth, as well as on physical activity to strengthen the muscle corset. Additionally, a course of vitamins may be prescribed.
Indications and contraindications
The main reasons for using epidural anesthesia are stated above, but it is worth talking directly about the indications and contraindications of this method. For example, in relation to childbirth, indications may include:
- the patient has excessive pain or a low pain threshold;
- C-section;
- lack of air in a child;
- a large number of fruits;
- discoordination of labor;
- protein in urine;
- the presence of serious pathologies in the expectant mother;
- incorrect position of the baby.
About the indications for
this type of anesthesia is also prescribed if surgery is required on the lower extremities or digestive organs and it is necessary to eliminate muscle spasms and reduce blood loss.
How is epidural anesthesia performed during childbirth?
However, anesthesia is prohibited if:
- inflammatory processes inside the spinal column;
- heart problems;
- scoliosis;
- bacteremia, that is, the content of bacteria in the blood;
- pathologies of the nervous system;
- suppuration and rashes on the skin;
- allergic reactions to the drug;
- low blood clotting.
Poor blood clotting
One of the advantages of the method is that it can be performed in some cases even in the presence of an intervertebral hernia. The procedure will not have a negative impact on the condition of the discs.
Left – injection into the epidural space
Where did it come from?
Spinal anesthesia was first used by several German doctors. In 1884, the anesthetic properties of cocaine when applied topically were discovered, and already in 1897, the German surgeon August Bier used a spinal needle, developed at the University of Berlin by Heinrich Quincke, to inject cocaine into the subarachnoid space. During the initial experiments, Beer and his student A. Hildebrandt, as often happened at that time, experimented on themselves and each other. Having made sure of the unambiguous effectiveness of the anesthesia obtained, the experimenters also scooped up all the “delights” of its side effects with a spoonful. These annoying effects have long held back the introduction of spinal anesthesia into widespread clinical practice. Fortunately, with the development of medical science, the improvement of medical equipment and the development of new anesthetics, the incidence of these complications has decreased significantly and spinal anesthesia, having become relatively safe, has become the main method of regional anesthesia used in the clinic today.
