By Isabel Moragues MD, PhD, MSc (senior embryologist).
Last Update: 07/24/2014

Epidural anesthesia is a term strongly associated with delivery and/or caesarean section. It is considered to be the safest type of anesthesia, and also the modality that produces the less secondary effects. Despite that, there is some controversy surrounding its use, as it has proponents an critics. The former argue that it does not interfere in the consciousness and mental clarity of the mother, whereas it wholly relieves pain. The detractors, on the other hand, note that induced deliveries are risky.

The epidural or peridural anesthesia is the introduction of a local anesthetic in the epidural space, so that the nerve endings are blocked and no signals are transmitted through them near the spinal cord. It was discover by the Spanish surgeon Fidel Pagés.

The technique of epidural puncture can be performed at different levels (caudal, cervical or lumbar), being the most common the lumbar puncture, performed between the lumbar vertebra, which spreads around the abdominal area.

The different sections of this article have been assembled into the following table of contents.

Indications for epidural anesthesia

The epidural may be used in abdominal interventions, especially those at a infra-umbilical level, such as deliveries, inguinal hernias and testicle or bladder interventions.

The drugs usually introduced are local anesthetics, whose effect is determined by the administered dose, low doses relief pain, whereas big doses produce muscular blockage and paralysis.

As any other anesthesia, epidural has a series of contraindications. Obese patients or with cardiomyopathies, situations where the delivery is very dilated and patients with tattoos in the lumbar area should not use epidural anesthesia.

Obviously, epidural has advantages and disadvantages, although its popularity is still riding high. We should familiarised with the technique and gather all the information available to make a thoughtful choice where is a go or a no-go.

Childbirth using epidural

Disadvantages and advantages

We find, amongst its disadvantages, the following:

  • Epidural is not infallible, it does not always work efficiently.
  • Its application implies an induced childbirth, increasing the likelihood of performing and episiotomy and a forceps delivery.
  • The concentration of anesthetic may cause a loss of muscular strength and sense of contraction. As a result of that, the second par of the delivery is slower, as the mother will be forced to relay on the instructions of the midwife to know when to push.

The advantages are listed below:

  • The effect lasts nearly 2 hours, although it is adjustable. That means it can be reinforced or diminished in order to have control over the delivery process.
  • It tends to slow the delivery down, which can be useful.
  • It entirely relieves pain without weakening the mental faculties of the patient, thus permitting active involvement of her in case of caesarean.
  • It prevents the necessity of applying another anesthetic in case forceps, episiotomy or a ventouse are required.

In summary, the epidural, as any other anesthetic, has its advantages and disadvantages. That is the reason why we should make sure we have all the information available to make a free, sound decision, always following the advice of a doctor.

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Authors and contributors

 Isabel Moragues
MD, PhD, MSc
Senior Embryologist
Bachelor's Degree in Biology and Biochemistry from the Universities of Alicante and Miguel Hernández of Elche. PhD with Cum Laude distinction in Biological Sciences from the University of Alicante. Master's Degree in Human Reproduction Biology from the Miguel Hernández University of Elche. Senior Embryologist and Specialist in Clinical Genetics with more than 15 years of experience. Director of IVF laboratories in various private fertility clinics. More information
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