When the delivery is near, the question arises: opt for an anesthesia so as not to feel pain or face the moment of delivery with other pain control techniques, without anesthesia involved.
Among the analgesics, the queen is the epidural , which allows the woman to be aware of the birth but without feeling pain from the waist down. Unfortunately, this also has its drawbacks: what happens if there is no effect? The possibility exists, and it is a consequence of the lateralization of the anesthesia or, what is the same, that one side falls asleep from the waist down, but that the pain is still felt in the other half. We ask an anesthetist when it can happen and why.
When Epidural Anesthesia May Not Work
According to Dr. Jaime Fandiño, anesthetist at the Vithas Nuestra Señora de Fátima Hospital (Vigo), there are different reasons why epidural anesthesia may not work: infection in the area, patients with coagulopathies or anticoagulant treatment, allergy to local anesthetics, certain spina bifida diseases …
In addition, the epidural, like the rest of the locoregional analgesics (which produce the nerve blockage of an area of the body), is an all or nothing technique. “If the technique is correct, the catheter is in the right place, and if the correct dose and concentration of analgesia is administered, it will always have an effect,” says the doctor. And adds:
What is lateralization of anesthesia
It means that after administering the epidural, one side may hurt and the other side may not. Lateralization of anesthesia is among the most common epidural failures. According to a study on epidural complications performed with more than 400 patients:
“In the peripartum period, the following complications were identified more frequently: unilateral analgesia (16.4%) , blood puncture (8.7%), paresthesias (8.2%), difficult technique (5.2%) , ineffective analgesia (2.7%), hypotension (2.5%) and subdural block (0.2%) “.
According to the anesthetist, the lateralization is due to an excessive introduction of the catheter and, “it has an easy solution, most of the time: withdrawing it slightly, without the need to repeat the technique.”
Patchy epidural
Another problem that can arise when applying anesthesia is what is known as a ‘patched epidural’, which implies, according to the doctor, that some area may remain sensitive .
“It is due to the septations of the epidural space (the area of the back where anesthesia is applied) that cause the local anesthetic not to arrive, even if it has been administered correctly.”
But it also has an easy solution, according to the expert:
“If the area is small and its impact is also small, it is usually not necessary to repeat the technique. If necessary, the epidural catheter will be repositioned, always assessing risk-benefit.”
Most of the time, epidural anesthesia works well and has no drawbacks, but as we can see, there are also some. Therefore, it is important to inform yourself and evacuate all the doubts that may arise about epidural anesthesia before the moment of delivery, as well as to elaborate a birth plan with your preferences on the procedures to be carried out at the time of birth.
What was your experience with the epidural? Did you have any complications? Would you ask for it again?
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