Everything You Need to Know About Epidurals

What is an epidural? Are epidurals safe? In this medical education video, double-boarded pain specialist and neurologist Dr Sader discusses the 2 main uses of epidurals (for analgesia during labor or after some surgeries, and for chronic pain relief for disc-related low back pain). He explains the indications, the procedure itself, as well as the risks and complications, including the feared post-dural puncture headache.

Just like an IV line goes intra-venously, an epidural refers to an injection in the epidural space, which is the space outside the dura (meninges covering the spinal cord and brain). The epidural space is made of fat and small vessels.

Epidural analgesia during labor involves injecting local anesthetic (such as lidocaine) to numb the skin, which is followed by entry of the epidural needle. Once the epidural needle reaches the epidural space, we get a loss of resistance, and a catheter can be threaded to infuse the medications (usually a local anesthetic and opioid). The goal is to achieve pain control without causing motor weakness. The catheter is removed a few hours or days later once no longer needed.

Epidural risks and complications include epidural hematoma (bleeding inside the spine), abscess (infection), local anesthetic toxicity, itching, motor block, and spinal headache. CSF leak can happen if an epidural needle inadvertently punctures the dura, or if the procedure was a combined epidural-spinal or a spinal where the needle is expected to puncture the dura. The risk of spinal headache depends on various factors including size and type of the needle used. Spinal headache is orthostatic, and gets significantly worse upon standing. If conservative management fails, an epidural blood patch can be done to seal the hole in the dura.

Epidural steroid injections follow a similar principle, but they are a one-shot injection, without the use of a catheter, and they are usually done under fluoroscopy (C-arm or X-ray use) to visualize the spine and identify the epidural space with contrast dye. Steroid, instead of opioid, is injected here to decrease inflammation around the disc herniation or nerve root irritation and flush out the inflammatory mediators. It is generally considered safe to get up to 4 epidural steroid injections per year.


Footage from Storyblocks and Envato (licensed).

Let's Connect:
IG:   / doctor.painkiller  
TikTok:   / doctor.painkiller  
LinkedIn:   / elie-sader-a21573217  
Website: http://www.eliesadermd.com

Disclaimer: The information in this video is provided for general informational and educational purposes only and is not a substitute for medical advice. Before taking any actions based upon such information, we encourage you to consult with your own doctor.

Sader Consulting, LLC


#epidural #epiduralinjection #spinaltap #spine #anesthesia #backpain #backpainrelief #medicaleducation #doctor #chronicpain #labor #sciatica #pain #lumbar