When the epidural has no effect: lateralization of anesthesia

When the delivery is near, the question arises: opt for an anesthesia to avoid feeling pain or face the time of delivery with other pain control techniques, without anesthesia involved.

Among the analgesics, the queen is the epidural, which allows women to be aware of childbirth 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 is a consequence of the lateralization of anesthesia or, what is the same, that one side falls 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, an 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 ...

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In addition, the epidural, like the rest of locoregional analgesics (which produce the nerve block 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:

"Nowadays, low and very low doses are used to eliminate pain without causing motor blockage (decreased strength) and that the mother correctly pushes in the expulsion period." In Babies and more Anesthesia in childbirth: how many types exist and what advantages and disadvantages each of them have

What is the lateralization of anesthesia

It means that after administering the epidural, one side may hurt and the other side may not. The 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%), paraesthesia (8.2%), difficult technique (5.2%), ineffective analgesia (2.7%), hypotension (2.5%) and subdural block (0.2 %) ".

According to the anesthetist, lateralization is due to an excessive introduction of the catheter and,"It has an easy solution, most of the time: removing it slightly, without repeating the technique."

Patched epidural

Another problem that may arise when putting anesthesia is what is known as 'patched epidural', which implies, according to the doctor, that some area can maintain sensitivity.

"It is due to the partitions of the epidural space (the area of ​​the back where the anesthesia is placed) 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 too, it is not usually necessary to repeat the technique. If necessary, the epidural catheter will be repositioned, always assessing risk-benefit."

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Most of the time, epidural anesthesia works well and has no problems, but as we can see there are. Therefore, it is important to inform and evacuate all doubts that may arise about epidural anesthesia before the time of delivery, as well as develop a birth plan with your preferences on the procedures to be performed at the time of birth.

What was your experience with the epidural? Did you have any complications? Would you ask again?

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