Allergy to epidural. Managing Labor Epidurals for Patients with Lidocaine Allergy: A Comprehensive Guide

26.06.202315.06.2023 by alexxlab

How can labor epidurals be safely administered to patients with lidocaine allergies. What are the alternative anesthetic options for managing pain during childbirth. How does chloroprocaine patient-controlled epidural analgesia (PCEA) compare to traditional methods.

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Understanding Lidocaine Allergy and Its Impact on Labor Analgesia

Lidocaine allergy presents a significant challenge in managing labor pain, as it is a commonly used local anesthetic in epidural procedures. While allergies to local anesthetics are rare, they can pose serious risks during childbirth. This article explores the implications of lidocaine allergy and presents alternative solutions for effective labor analgesia.

What is Lidocaine and Why is it Commonly Used in Epidurals?

Lidocaine, first manufactured in 1943, is an amino amide local anesthetic widely used in medical procedures due to its excellent safety profile when administered in prescribed doses. Its popularity in labor epidurals stems from its rapid onset of action and effective pain relief properties.

How Common are Lidocaine Allergies?

True hypersensitivity reactions to local anesthetics are uncommon. Many adverse reactions are incorrectly labeled as allergic reactions. However, when a genuine allergy exists, it requires careful consideration and alternative approaches to pain management during labor.

Chloroprocaine: A Safe Alternative for Lidocaine-Allergic Patients

For patients with confirmed or suspected lidocaine allergies, chloroprocaine emerges as a viable alternative for labor analgesia. This amino ester local anesthetic offers several advantages in managing pain during childbirth.

Why is Chloroprocaine a Suitable Option?

Chloroprocaine belongs to a different class of local anesthetics (amino esters) compared to lidocaine (amino amides). This distinction significantly reduces the risk of cross-reactivity, making it a safer choice for patients with lidocaine allergies.

How is Chloroprocaine Administered During Labor?

Chloroprocaine can be administered through patient-controlled epidural analgesia (PCEA), allowing for personalized pain management. The typical protocol involves a basal rate infusion with optional boluses, providing continuous pain relief with the ability to adjust as needed.

Case Studies: Successful Labor Analgesia with Chloroprocaine PCEA

Two case studies demonstrate the effective use of chloroprocaine PCEA in managing labor pain for patients with lidocaine allergies.

Case Study 1: 25-Year-Old G2P1 Parturient

A 25-year-old woman with a history of childhood lidocaine allergy received chloroprocaine PCEA for labor analgesia. After careful skin testing and monitoring, she experienced comfortable pain relief and had a successful spontaneous vaginal delivery without allergic reactions.

Case Study 2: 36-Year-Old G2P1 Parturient

A 36-year-old woman with a history of throat swelling from lidocaine gargle opted for chloroprocaine PCEA. The procedure was successful, providing effective pain management throughout labor.

Precautions and Protocols for Administering Chloroprocaine PCEA

While chloroprocaine PCEA offers a promising solution for lidocaine-allergic patients, certain precautions and protocols must be followed to ensure safety and efficacy.

What Pre-Procedure Steps Should Be Taken?

Thorough patient history and allergy assessment
Skin testing with incremental doses of chloroprocaine
Preparation of emergency equipment, including a code cart
Coordination with the obstetric team for potential emergency scenarios

How is the Chloroprocaine PCEA Administered?

The typical protocol involves:

Initial skin numbing with a small dose of chloroprocaine
Epidural catheter placement
Loading dose administration
Initiation of PCEA pump with a set basal rate and optional boluses

Comparing Chloroprocaine PCEA to Other Pain Management Options

When lidocaine is not an option, healthcare providers must consider various alternatives for labor pain management. How does chloroprocaine PCEA compare to other methods?

Chloroprocaine PCEA vs. IV Opioid-Based Analgesia

Intravenous opioid-based analgesia, such as remifentanil PCA, is another option for lidocaine-allergic patients. However, it has several drawbacks:

Potential harmful effects on both mother and baby
Sedative properties that may decrease maternal participation in the birthing process
Less effective pain relief compared to epidural analgesia

Chloroprocaine PCEA, on the other hand, provides localized pain relief without systemic effects, allowing for a more alert and participatory birthing experience.

Long-Term Considerations and Follow-Up for Lidocaine-Allergic Patients

Managing labor analgesia for lidocaine-allergic patients extends beyond the delivery room. What long-term considerations should be addressed?

Importance of Allergy Specialist Consultation

Patients with suspected lidocaine allergies should be advised to consult an allergist post-delivery. This follow-up is crucial for:

Confirming the nature and extent of the allergy
Exploring potential desensitization options
Providing guidance for future medical procedures requiring local anesthesia

Documentation and Future Care Planning

Proper documentation of the allergy and successful alternative anesthesia methods is essential for future medical care. This information should be readily available to healthcare providers to ensure safe and effective pain management in subsequent procedures or pregnancies.

Advancing Research and Practice in Local Anesthetic Allergies

The successful use of chloroprocaine PCEA in lidocaine-allergic patients opens up new avenues for research and clinical practice. What areas require further exploration?

Expanding the Evidence Base

While case reports and small series provide valuable insights, larger studies are needed to:

Establish the safety profile of chloroprocaine PCEA in a broader patient population
Optimize dosing protocols for maximum efficacy and minimal side effects
Compare outcomes with traditional epidural techniques

Developing Standardized Protocols

As the use of chloroprocaine PCEA becomes more widespread, there is a need for:

Standardized protocols for patient selection and administration
Training programs for anesthesiologists and obstetric care providers
Guidelines for managing potential complications specific to chloroprocaine use

The Future of Labor Analgesia for Allergic Patients

The successful management of labor pain in lidocaine-allergic patients using chloroprocaine PCEA represents a significant advancement in obstetric anesthesia. As awareness grows and more practitioners gain experience with this technique, what can we expect for the future of labor analgesia?

Personalized Anesthesia Plans

The ability to offer safe and effective alternatives to patients with local anesthetic allergies paves the way for more personalized anesthesia plans. This tailored approach can:

Improve patient satisfaction and outcomes
Reduce anxiety related to allergic concerns during labor
Potentially increase the number of patients who can benefit from epidural analgesia

Technological Advancements

As research in this area progresses, we may see:

Development of new local anesthetic formulations with even lower allergenic potential
Advanced delivery systems for more precise control of analgesia
Improved monitoring techniques to detect and prevent allergic reactions

Broader Implications for Anesthesia Practice

The successful use of chloroprocaine in labor analgesia may have broader implications for anesthesia practice, potentially influencing:

Approaches to regional anesthesia in other surgical specialties
Management of local anesthetic allergies in non-obstetric patients
Development of protocols for rapid allergy testing and desensitization

In conclusion, the management of labor epidurals in patients with lidocaine allergies represents a complex but surmountable challenge in obstetric anesthesia. The use of chloroprocaine PCEA offers a promising solution, providing effective pain relief while minimizing allergic risks. As research and clinical experience in this area grow, we can anticipate further refinements in technique and broader applications of alternative local anesthetics in various medical fields. This progress not only enhances the safety and comfort of childbirth for allergic patients but also contributes to the overall advancement of personalized and patient-centered care in anesthesiology.

Labor Epidural in a Patient Who is Allergic to Lidocaine: A Case Series

Local Reg Anesth. 2021; 14: 21–23.

Published online 2021 Feb 16. doi: 10.2147/LRA.S253087

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Author information Article notes Copyright and License information Disclaimer

Continuous epidural anesthesia is considered the best modality for pain relief during labor, local anesthetic allergy is an uncommon occurrence but if a patient has an allergy to bupivacaine or lidocaine owing to its cross-reactivity with bupivacaine then it becomes very challenging to manage labor analgesia. A direct challenge test to rule out actual hypersensitivity was not considered a viable option given the risks involved if a severe allergic reaction occurred with the test dose. Using IV opioid-based analgesia has harmful effects for both mother and the baby in addition to decreasing participation of mothers in the birthing process owing to its sedative properties. We report two cases where the mother had a history of lidocaine allergy, so labor analgesia was managed using chloroprocaine patient-controlled epidural analgesia (PCEA).

Keywords: lidocaine allergy, labor analgesia, chloroprocaine epidural, local anesthetic allergy, chloroprocaine patient-controlled epidural analgesia

Local anesthetics are very commonly used drugs. Lidocaine after being first manufactured in 1943 is still extensively used with a good safety record if given in prescribed dose. Hypersensitivity reaction to local anesthetics are rare and many adverse reactions are mislabeled as an allergic reaction.³ Local anesthetics are primarily of two types amino amides and amino esters. Both lidocaine and bupivacaine are amino amides and share some cross-reactivity concerning allergic reactions.³ Our patients had an allergic reaction to the amino amide class of local anesthetic namely lidocaine, so we decided to use an amino ester local anesthetic chloroprocaine instead. The use of chloroprocaine in PCEA is not a widely accepted practice and is mostly documented in case reports or small series. Mention of chloroprocaine safe usage in literature may prompt its wider usage.

A 25-year-old G2P1 parturient with no major co-morbidity except for the history of lidocaine allergy in childhood presented to our hospital with 37 weeks’ gestation in an active phase of labor. She did not remember the exact details of allergic reaction as it “occurred in childhood”. Her airway exam was reassuring. Though direct challenge can be tried with non-proven local anesthetic allergy,⁴ or skin testing, it was not planned considering the risk for the mother and the baby in case of anaphylaxis. We discussed at length the possible pain relief modalities including the risk and benefits of chloroprocaine PCEA and remifentanil intravenous (IV) patient-controlled analgesia (PCA). The patient opted for chloroprocaine PCEA after understanding the risks and the benefits. Standard ASA monitors were applied, an 18G IV was placed, and the patient was prepared for the procedure with the code cart in the labor room. The obstetric team was made aware to be on standby if anaphylaxis occurred and stat delivery of the fetus was necessary. We performed skin testing with 0.1 mL of chloroprocaine subcutaneously, followed by 0.5mL and 1 mL of the same, no allergic reactions were noted, and the vital signs were stable 2 mL of chloroprocaine 1.5% (Nescaine MPF) was used to numb the skin. The epidural catheter placement was performed easily, and 8 mL of chloroprocaine 1.5% was used as a loading dose. A pump for patient-controlled epidural analgesia (PCEA) at a basal rate of 12 mL/hr of chloroprocaine 1.5%+ fentanyl 2mcg/mL with optional boluses of 5 mL every 20 minutes was started. She was closely monitored for any symptoms of allergic reactions. She was comfortable, with no symptoms of allergic reactions, and had a spontaneous vaginal delivery, after eight hours without issues. Mother and baby were discharged home on the third postpartum day. Our patient was advised to visit an allergist six months post-delivery.

A 36-year-old G2P1 parturient with a history of gastroesophageal reflux disease with the fetus in a cephalic presentation in an active phase of labor requested labor analgesia. She reported a history of swelling of the throat on lidocaine gargle years prior. She had reassuring airway, cardiac, liver, lung, and kidney functions. The patient decided to proceed with the epidural analgesia using chloroprocaine for pain relief, after discussing the options available. The code cart was kept in the room, and the obstetric team was made aware. The epidural catheter placement was done and a pump for patient-controlled epidural analgesia (PCEA) at a basal rate of 12 mL/hr of chloroprocaine 1.5%+ fentanyl 2mcg/mL with optional boluses of 5 mL every 20 minutes was started. However, the patient reported severe back spasm, which she described as burning pain deep in the muscles and was not willing for the continuation of epidural boluses of chloroprocaine. After a total of 30 mL was infused PCEA was discontinued. After an hour, the Ob team treated her with intermittent doses of Stadol (nalbuphine). The patient was comfortable with the intermittent boluses of nalbuphine, and she delivered a healthy baby after ten hours.

Epidural anesthesia is considered the best modality for labor analgesia.¹^,² With intravenous opioid-based analgesia marred with lesser pain relief and a higher rate of adverse effects.^4–7 True allergy to local anesthetic is not common.⁸ Allergic reaction is commonly triggered by preservative methylparaben, para-aminobenzoic acid which is a metabolite of the amide group of local anesthetics, or ester or amide component.^9–11

If allergy to local anesthetic is reported it is very important to evaluate it further pre-conception or early in pregnancy. First is a careful history as symptoms like palpitations, vasovagal attacks, and anxiety during the IV injections can be mistaken for allergic reactions by the patient. ⁸ A detailed history should be elicited for true allergic reactions like rashes, bronchospasm, urticarial, angioedema, and cardiovascular collapse.⁸ If allergy to lidocaine is true, bupivacaine cannot be used as it is also an amide group local anesthetic and has cross-reactivity with lidocaine² though the exact rate is not known. Skin testing or challenge dose of local anesthetic can be used⁴ and would have been ideal if this patient was reviewed pre-conception or in the second trimester.

Chloroprocaine is a fast-acting local anesthetic with a short duration of action and belongs to the ester group with no cross-reactivity to lidocaine which is an amide. It is rapidly hydrolyzed by plasma esterases. Chloroprocaine is very rarely used in labor epidural anesthesia possibly due to the possibility of cauda equina syndrome and arachnoiditis with unintentional intrathecal administration.¹² Now the preservative-free chloroprocaine is being used as a spinal anesthetic without complications. ¹³

The dosing of chloroprocaine has not been standardized yet and we used the dose used by Lee¹⁴ though lower dosing has been recommended by Coffman et al.¹⁵ As a conclusion, we would say that local anesthetic allergy is reported it should be evaluated early and in pregnancy and chloroprocaine, epidural analgesia is an underutilized modality of pain relief. We would also agree with Coffman et al to decrease the dosing needed to further increase the safety profile and think that it should be further evaluated to standardize the dosing regimen. The downside of the chloroprocaine is the back muscle spasms as in our case 2 and the unintended motor blockade which could be uncomfortable for the patient. Muscle spasms are more common with chloroprocaine containing EDTA as a preservative with doses of more than 40mL. In our patient, a total of 30mL was used before it was discontinued.

Appropriate alternative medications can be used only if we understand the basic pharmacology of the medications. It is crucial to elicit a detailed history regarding the allergic reaction as we can rule out the side effects of the medications which could be misinterpreted as an allergic reaction by the patients. Clinicians should be aware of the necessity of the proper evaluation of the patients who report a local anesthetic allergy to an allergist and an anesthesiologist early in pregnancy.

We appreciate the input of Dr. Minal Joshi.

Both the patient’s informed consent was obtained for the publication of the report. Study was approved for publication by New York-Presbyterian Brooklyn Methodist Hospital institutional review committee.

None of the authors have any conflicts of interest to disclose.

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11 Risks of Epidurals During Delivery: Itching, Fever, and More

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Medically reviewed by Karen Gill, M. D. — By The Healthline Editorial Team on February 9, 2018

What is an epidural block?

The act of delivering a baby lives up to its name. Labor is hard, and painful, work. To make the experience more comfortable, women have a few options for pain relief, including epidurals and spinal blocks. Here’s how they’re different:

Epidural block. For women in the United States, this is the most commonly used form of pain relief during labor. It combines analgesic and anesthetic pain relievers, which are delivered through a tube in your back. The medication blocks pain signals before they can get to your brain. Once you’ve had the injection, you’ll lose some feeling below the waist, but you’ll be awake and able to push when the time comes.
Spinal block. A spinal blockalso numbs you from the waist down, but the medication is delivered via a shot into the fluid around your spinal cord. It works quickly, but the effects only last for an hour or two.
Combined spinal-epidural block.This option offers the advantages of both types of anesthesia. It goes to work quickly. The pain relief lasts longer than a spinal block alone.

Both epidural blocks and combined spinal-epidural blocks make labor a less laborious and painful experience, but they’re not risk-free. These drugs can have side effects, such as low blood pressure, itching, and headache. Though rare, some side effects associated with epidurals can be serious.

Being aware of these side effects ahead of time can help you decide which option to choose.

What are the common side effects?

Common side effects range from itching to difficulty urinating.

Itching

Some of the medications used in an epidural — including opioids — can make your skin itch. A change in medication can relieve this symptom. Your doctor might also give you medication to relieve the itch.

Nausea and vomiting

Opioid pain relievers can sometimes make you feel sick to your stomach.

Fever

Women who get an epidural sometimes run a fever. According to PubMed Health, about 23 percent of women who get an epidural run a fever, compared to about 7 percent of women who don’t get an epidural. The exact reason for the spike in temperature is unknown.

Soreness

After your baby is born, your back might feel sore, but the feeling should only last for a few days. Back pain is also a common side effect of pregnancy, as the weight of your belly puts extra strain on your back. Sometimes it’s hard to tell whether the cause of your soreness is the epidural, or residual strain from the added weight of pregnancy.

Low blood pressure

About 14 percent of women who get an epidural block experience a drop in blood pressure, although it’s usually not harmful. An epidural block affects nerve fibers that control muscle contractions inside the blood vessels. This causes the blood vessels to relax, lowering blood pressure.

If the blood pressure drops too low, it can affect blood flow to your baby. To reduce this risk, most women get intravenous (IV) fluids before the epidural is placed. Your blood pressure will also be checked during labor. You’ll get medication to correct it, if needed.

Difficulty urinating

After an epidural, the nerves that help you know when your bladder is full will be numb. You may have a catheter inserted to empty your bladder for you. You should regain bladder control once the epidural wears off.

What are the rare side effects?

Rare side effects associated with epidurals range from breathing problems to nerve damage.

Breathing problems

In rare cases, the anesthetic can affect the muscles in your chest that control breathing. This can lead to slowed breathing or other breathing problems.

Severe headache

If the epidural needle accidentally punctures the membrane covering the spinal cord and fluid leaks out, it can cause a severe headache. This only happens in about 1 percent of deliveries with epidurals, according to the American Society of Anesthesiologists. The headache is treated with oral pain relievers, caffeine, and plenty of fluids.

If these doesn’t relieve the headache, the doctor performs a procedure called an epidural blood patch. A small sample of your blood is injected into the hole. When the blood clots, the hole closes and the headache should stop. Most new mothers get relief within one or two hours of having this procedure.

Infection

Any time you create an opening in the skin — such as with a needle — bacteria can get inside and cause an infection. It’s rare to have an infection from an epidural. This is because the needle is sterile and your skin is cleaned before it’s inserted. However, it can happen. The infection can spread to other parts of your body, too, but this is even more rare.

Seizure

In rare cases, an epidural can trigger a seizure if the pain medication gets into your vein. A seizure is shaking or convulsions due to abnormal electrical activity in your brain.

Nerve damage

The needle used to deliver the epidural can hit a nerve, leading to temporary or permanent loss of feeling in your lower body. Bleeding around the area of the spinal cord and using the wrong medication in the epidural can also cause nerve damage.

This side effect is extremely rare. It affects only 1 in 4,000 to 1 in 200,000 people who have an epidural block, according to the American Society of Regional Anesthesia and Pain Medicine.

Let your anesthesiologist know right away if you have symptoms such as numbness or tingling after the epidural is supposed to have worn off.

Epidurals and assisted births

Having an epidural can increase the amount of time you spend in the second stage of labor. This stage starts when your cervix is fully dilated and ends when your baby is born. Women who have an epidural can spend an extra hour in this stage of labor.

When your labor progresses too slowly, your doctor is more likely to recommend help getting your baby out. Past research showed that women who got epidurals were more likely to need a cesarean delivery. More recent studies find that this may not be true, but you may be more likely to need an assisted delivery with a vacuum or forceps if you have an epidural.

In one study done in Great Britain, the instrument-assisted delivery rate was 37.9 percent in women who’d had an epidural, compared to 16.4 percent in those who didn’t.

What’s the outlook?

Most risks from epidurals are either mild or rare. If a highly trained anesthesiologist performs your epidural or spinal block, your odds of having a complication decrease.

Meet with your anesthesiologist before your due date. Ask about their experience. Work together to create a pain relief plan that works for you.

Remember that you do have other choices besides an epidural for pain relief. Some techniques involve medication, while others are natural. Labor pain relief options include:

deep breathing techniques
acupuncture and acupressure
relaxation exercises
support from a doula or labor coach
water immersion
inhaled pain medication, such as nitrous oxide
opioids

Talk to your doctor about the advantages and disadvantages of each technique. Medication provides the greatest pain relief, but it can cause side effects. Natural techniques will help you avoid side effects, but they may not cut through your pain. Make the decision based on your personal preferences and ability to tolerate pain.

Last medically reviewed on February 9, 2018

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Feb 9, 2018

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Medically Reviewed By

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Medically reviewed by Karen Gill, M.D. — By The Healthline Editorial Team on February 9, 2018

media about INVITRO.

Olesya Butuzova

Any pregnant woman is waiting for childbirth – the long-awaited moment of meeting her baby. However, many also experience a contradictory feeling – fear. As a rule, most women who have heard enough stories of “experienced” girlfriends are afraid of pain. That is why a modern pregnant woman thinks not only about the name for the future crumbs, but also about … pain relief. The most common and, perhaps, the favorite method of pain relief during childbirth is currently epidural anesthesia.

The essence of this pain relief technique is to inject a local anesthetic under the dura mater of the spinal cord, where the roots of the spinal nerves pass. By “stunning” them, you can save the pregnant woman from pain.

Why is epidural anesthesia good?

Epidural anesthesia is not in vain so popular among both obstetrician-gynecologists and women in labor. It eliminates the pain and gives the woman the opportunity to rest. With a small injection of the drug, the woman in labor can move independently without experiencing discomfort. During the caesarean section, the mother is conscious and does not miss the wonderful moment of the first meeting with the baby.

As a rule, the administration of the drug is carried out in doses, it comes directly to the destination – to the nerve roots, therefore, the dosages are minimal. All this allows the liver to quickly cleanse the blood and dispose of the remnants without missing the medicine to the baby. Thus, epidural anesthesia is practically safe for the baby.

Only pain relief?

Initially, the purpose of epidural anesthesia was not to facilitate the process of childbirth for mothers, but to stop certain threatening conditions.

Thus, epidural anesthesia has a number of beneficial effects:
Eases the pain of childbirth and gives the woman the opportunity to rest and gain strength for the important period of attempts.
Reduces high blood pressure, hyperventilation of the lungs and adrenaline levels, which has a calming effect on the body. Epidural anesthesia facilitates the opening of the cervix and reduces trauma during preterm labor, coordinates contractions and the work of the muscles of the uterus.
And, most importantly, such pain relief is much safer than using intravenous drugs.

How is the procedure carried out?

In order to puncture, the doctor must first position the pregnant woman correctly (which can be difficult with painful contractions). It is recommended that the woman in labor sit on a chair, facing the back or lie on her side, curled up.

The puncture site is carefully cleaned with antiseptic solutions to minimize the risk of infection.

The skin and subcutaneous tissue are punctured with a local anesthetic to numb the insertion of a needle under the dura mater of the spinal cord.

With a special needle, the doctor enters the epidural space and passes a catheter through it, through which the drug is delivered.

Medical indications for epidural anesthesia:

Caesarean section.
Diseases of the heart, including defects, – the load on the heart decreases.
Diseases of the kidneys.
Diabetes mellitus.
High blood pressure. Epidural anesthesia helps to reduce it.
Preterm pregnancy. Epidural anesthesia helps to relax the muscles of the pelvic floor and reduce the resistance exerted by the baby’s head. The baby comes out smoothly and gently.
Discoordination of labor – a condition in which contractions become irregular, frequent, painful and unproductive. They exhaust a woman, but do not contribute to the birth of a child. Epidural anesthesia puts in order the tone of the uterus and muscle contractions, thereby coordinating labor activity.

But epidurals are not for everyone. There is a whole list of contraindications to such anesthesia.

Our expert

Alla Misyutina, doctor of the INVITRO Medical Offices Department

in this situation, anesthesia can be dispensed with altogether . However, epidural anesthesia is one of the preferred methods of anesthesia in obstetrics. The onset of action of this pain relief is gradual and slow. Pain relief usually develops 10-20 minutes after epidural administration and may be continued until the end of labor as additional doses of drugs can be administered through the epidural catheter. After childbirth, the catheter is removed and after a few hours all sensations return to normal. Anesthesia involves a complete blockage of sensations and movements, it is used more often during a caesarean section.

Epidural analgesia is sometimes performed during childbirth, with the help of which only painful sensations are removed. Then the nerves responsible for motor functions remain partially in working order, and if desired, the woman can move – roll over, sit down, stand. Contractions become painless and are felt by the woman in labor only as pressure below, on the rectum. With a competent approach of doctors – gynecologists and anesthesiologists – the risk is minimal. Obstetrician-gynecologists widely promote this type of pain relief, and many women easily agree to its use.

About side effects

But, like any other useful medical manipulation, epidural anesthesia is not without side effects.

The most common is lowering blood pressure. This is fraught with impaired placental blood flow and hypoxia, that is, oxygen starvation in the baby.

The second serious reaction may be allergic. To prevent anaphylactic shock at the beginning of the procedure, a trial administration of the drug is carried out. If the woman in labor felt pain, burning or itching in the puncture area, then the doctors “cover up” the anesthesia with antiallergic drugs.

When pierced, the drug may enter the spinal canal, which is fraught with difficulty breathing and a drop in blood pressure. It is also possible to injure the roots of the spinal nerves and pain in the limbs. When the drug is injected under the dura mater of the spinal cord, there is a risk of getting into the epidural veins. In such cases, severe complications develop – a sharp drop in blood pressure, heart rhythm disturbance and dizziness. Often this situation is accompanied by numbness of the tongue.

Bacteria entering the puncture site can lead to meningitis.

If the dura mater is damaged and, as a result, cerebrospinal fluid enters the epidural space, headache may occur. It appears a few days after childbirth and can last up to a month and a half.

With regard to side effects on the part of the child, this may be respiratory depression, dysmotility, difficulty sucking.

However, I would like to note that according to statistics, all these complications are rare.

Thus, epidural anesthesia is an effective way of pain relief during childbirth, helping the mother to gain strength before meeting the baby. As well as a medical procedure that eliminates a number of complications during childbirth. Although whether to use epidural anesthesia, if there is no indication for it, is, of course, up to you to decide.

List of contraindications for epidural anesthesia:

High intracranial pressure.
Low blood pressure (below 100 mmHg).
Curvature of the spine.
Unconscious state of a woman in labor.
Sepsis.
Bleeding or bleeding disorder.
Serious neurological or mental illness of the woman in labor.
Allergy to drugs used for epidural anesthesia.

Allergic reaction and medical error.

Why do people die from drugs? | HEALTH: Medicine | HEALTH

October 16 is World Anesthetist Day every year. anesthesiologist-resuscitator of the Emergency Hospital No. 1 Vladimir Zeitlenok spoke about complications after anesthesia, anaphylactic reaction and anesthesia in the office of the dentist “AiF-Voronezh”.

“The main complication is death”

Faina Mania, AiF-Voronezh: Vladimir Yurievich, are there any categories of patients who are contraindicated for general anesthesia?

Vladimir Zeytlenok : Anesthesia protects a person from pain during surgery, stabilizes his condition. Anesthesia is contraindicated only for those who are categorically against it. Moreover, a person must make this decision, being in a clear mind. True, in my practice there were no such cases.

– It turns out that the patient decides what to do or not to do anesthesia? What if it’s a complex operation?

– If a person refuses anesthesia before a major operation, then the only thing the doctor can offer is local methods of anesthesia.

– What complications can occur after anesthesia?

– The main complication is death. You can actually die from anesthesia. And there are several reasons. First, let’s clarify what anesthesia is. This is an acute poisoning of the body with approved medications, controlled by doctors. But the medications that are used for anesthesia, give their complications. They can lead to an anaphylactic reaction. Sometimes allergic reactions are so severe that they can lead to death. Another reason lies in the fact that the vast majority of drugs for anesthesia affect the heart and blood vessels. This can lead, for example, to heart failure. Another reason is medical error. At the institute, we were taught that in medicine it is important to be guided by two principles – do no harm and get by with a minimum of drugs. If, for example, the doctor decides to use additional drugs that could be dispensed with during anesthesia, this is only his fault.

– Is it possible to somehow protect a person, for example, from an anaphylactic reaction?

– Unfortunately not. This is a coincidence. Yes, before surgery, a person is asked if they have any allergies to food or medications. And it’s one thing when a patient admits that he has, for example, an allergy to novocaine, and the doctor still uses the drug. Then the blame will lie with the health worker. And it’s a completely different matter when a person says that he has never had any allergies. The patient is placed under anesthesia and develops an anaphylactic reaction. Who in this case will be to blame for death?

– Have there been such cases in your practice?

– For example, in my ten years in a commercial medical organization, I have come across five cases of anaphylactic reaction. Four of them were fairly mild, but one almost ended in death. Fortunately, the patient was able to pump out.

– Can anaphylactic shock occur not from the first time, but after several operations?

– Each time the possibility of an allergic reaction increases. After all, any drug is an allergen, and each time it enters the body, it causes the production of antigens.

Without pain and restrictions

– Is there any limit on the amount of anesthesia allowed for a person?

– Depending on the type of anesthesia, a person falls into a coma – superficial or deep. For example, from drinking alcohol, people also often fall into a coma and do not think about the harm. Often, patients who are in burn units are forced to do anesthesia almost daily. There, even the dressing is so painful that it is performed under anesthesia. And they can lie in the department for months. At the same time, completely normal people are discharged from the hospital.

– It turns out that anesthesia does not affect intellectual abilities in any way?

– Narcosis can only affect a person’s intellectual abilities for a short time. But the recovery is very fast.

– Is it true that during anesthesia a person sees hallucinations?

– During anesthesia, the person is unconscious and cannot see anything. But when the patient enters or comes out of anesthesia, he can see hallucinations.

– What pain sensations are considered acceptable after anesthesia?

– This may be pain that does not interfere with movement. The person should have no problem turning around, breathing deeply, drinking water or eating if allowed. And it is important to start walking as soon as possible so that there are no complications after anesthesia or surgery.

– What is the best way to extract a tooth – with or without anesthesia?

– Not everyone wants to be conscious, and there are people who simply cannot bear the pain. Children under 12 must be given local anesthesia, because they are very difficult to tolerate stressful situations. If you do conduction anesthesia, then you can remove not only the tooth, but the entire jaw.

– How do you feel about epidural anesthesia during childbirth? What are its pros and cons?

– As I said, not all people can bear pain.