Sunday, 19 August 2018

An epidural is an injection in the back to stop you feeling pain in part of your body

This page covers epidural anaesthesia, a type of epidural commonly given for pain relief in childbirth and in some types of surgery.

When epidurals are used
Epidurals can be used:

during childbirth, including caesareans
during some types of surgery
after some types of surgery
Steroid medication can also be given as an epidural injection to treat back or leg pain caused by sciatica or a slipped (prolapsed) disc.

Preparing for an epidural
If you have any concerns or questions about having an epidural, discuss these with your doctor. Let them know about any medication you're taking.

You may be given specific advice about eating, drinking and medication before the epidural.

As you won't be able to drive for 24 hours after having an epidural, you'll need to arrange for someone to give you a lift home.

How an epidural is given
Epidurals are given by a specialist doctor called an anaesthetist.

You're usually awake during an epidural, but for some types of surgery you may have it while under general anaesthetic.

A drip will be placed in your arm so you can be given fluids while you're having the epidural.
You'll be asked to sit down and lean forwards, or lie on your side with your knees drawn up.
You'll be given an injection of local anaesthetic to numb the skin where the epidural is to be inserted.
A needle is used to insert a fine plastic tube called an epidural catheter between the bones of your back.
The needle is then removed, leaving just the catheter in your back.
You may feel mild discomfort when the epidural needle is positioned and the catheter is inserted.
The epidural can be inserted at different levels of your back depending on the area of the body that requires pain relief.

Pain relief drugs are then given through the catheter. These take about 20-30 minutes to take full effect.

Your chest, tummy and legs may feel numb while the epidural is being used, and your legs may not feel as strong as normal.

While the catheter remains in your back, it can be used to top up your pain relief drugs manually or using an automatic pump.

This can be for several hours (during childbirth) or for a few days (after major surgery).

Mobile epidurals, which use a lower dose of pain relief drugs, are sometimes used in childbirth, allowing you to walk around during labour.

Recovering from an epidural
When the epidural is stopped, the numbness usually lasts for a few hours before its effects begin to wear off.

While the drugs wear off, you'll probably be advised to rest in a lying or sitting position until the feeling in your legs returns.

This can take a couple of hours, and you may feel a slight tingling sensation in your skin.

Tell the doctor or nurse if you feel any pain. They can give you medicines to help control it.

Do not drive, operate machinery or drink alcohol for 24 hours after having an epidural.

Risks and side effects of an epidural
Epidurals are usually safe, but there's a small risk of side effects and complications, including:

low blood pressure, which can make you feel lightheaded or nauseous
temporary loss of bladder control
itchy skinEpiglottitis is inflammation and swelling of the epiglottis. It's often caused by an infection, but can also sometimes occur as a result of a throat injury.

The epiglottis is a flap of tissue that sits beneath the tongue at the back of the throat.

Its main function is to close over the windpipe (trachea) while you're eating to prevent food entering your airway.

Symptoms of epiglottitis
The symptoms of epiglottitis usually develop quickly and get rapidly worse, although they can develop over a few days in older children and adults.

Symptoms include:

a severe sore throat
difficulty and pain when swallowing
difficulty breathing, which may improve when leaning forwards
breathing that sounds abnormal and high-pitched (stridor)
a high temperature (fever) of 38C (100.4F) or above
irritability and restlessness
muffled or hoarse voice
The main symptoms of epiglottitis in young children are breathing difficulties, stridor and a hoarse voice.

In adults and older children, swallowing difficulties and drooling are the main symptoms.

When to seek medical advice
Epiglottitis is regarded as a medical emergency, as a swollen epiglottis can restrict the oxygen supply to your lungs.

Dial 999 to ask for an ambulance if you think you or your child has epiglottitis.

While waiting for an ambulance, you should not attempt to examine your child's throat, place anything inside their mouth, or lay them on their back. This may make their symptoms worse.

It's important to keep them calm and to try not to cause panic or distress.

Epiglottitis can be fatal if the throat becomes completely blocked. But most people make a full recovery with appropriate treatment.

Treating epiglottitis
Epiglottitis is treated in hospital. The first thing the medical team will do is secure the person's airways to make sure they can breathe properly.

Securing the airways
An oxygen mask will be given to deliver highly concentrated oxygen to the person's lungs.

If this does not work, a tube will be placed in the person's mouth and pushed past their epiglottis into the windpipe. The tube will be connected to an oxygen supply.

In severe cases where there's an urgent need to secure the airways, a small cut may be made in the neck at the front of the windpipe so a tube can be inserted. The tube is then connected to an oxygen supply.

This procedure is called a tracheostomy and it allows oxygen to enter the lungs while bypassing the epiglottis.

An emergency tracheostomy can be carried out using local anaesthetic or general anaesthetic.

Once the airways have been secured and the person is able to breathe unrestricted, a more comfortable and convenient way of assisting breathing may be found.

This is usually achieved by threading a tube through the nose and into the windpipe.

Fluids will be supplied through a drip into a vein until the person is able to swallow.

Once this has been achieved and the situation is thought to be safe, some tests may be carried out, such as:

a fibreoptic laryngoscopy – a flexible tube with a camera attached to one end (laryngoscope) is used to examine the throat
a throat swab – to test for any bacteria or viruses
blood tests – to check the number of white blood cells (a high number indicates there may an infection) and identify any traces of bacteria or viruses in the blood
an X-ray or a CT scan – sometimes used to check the level of swelling
Any underlying infection will be treated with a course of antibiotics.

With prompt treatment, most people recover from epiglottitis after about a week and are well enough to leave hospital after 5 to 7 days.

Why it happens
Epiglottitis is usually caused by an infection with Haemophilus influenzae type b (Hib) bacteria.

As well as epiglottitis, Hib can cause a number of serious infections, such as pneumonia and meningitis.

It spreads in the same way as the cold or flu virus. The bacteria are in the tiny droplets of saliva and mucus propelled into the air when an infected person coughs or sneezes.

You catch the infection by breathing in these droplets or, if the droplets have landed on a surface or object, by touching this surface and then touching your face or mouth.

Less common causes of epiglottitis include:

other bacterial infections – such as streptococcus pneumoniae (a common cause of pneumonia)
fungal infections – people with a weakened immune system are most at risk from these types of infection
viral infections – such as the varicella zoster virus (the virus responsible for chickenpox) and the herpes simplex virus (the virus responsible for cold sores)
trauma to the throat – such as a blow to the throat, or burning the throat by drinking very hot liquids
smoking – particularly illegal drugs, such as cannabis or crack cocaine
Hib vaccination
The most effective way to prevent your child getting epiglottitis is to make sure their vaccinations are up-to-date.

Children are particularly vulnerable to a Hib infection because they have an underdeveloped immune system.

Babies should be vaccinated against Hib as part of the 6-in-1 DTaP/IPV/Hib vaccine, which also protects against diphtheria, hepatitis B, tetanus, whooping cough and polio.

They should receive 3 doses of the vaccine: at 8 weeks, 12 weeks and 16 weeks of age. This is followed by an additional Hib/Men C "booster" vaccine at 1 year of age.

Contact your GP if you're not sure whether your child's vaccinations are up-to-date.

Read more about the childhood vaccination schedule.

Who's affected
Because of the success of the Hib vaccination programme, epiglottitis is rare in the UK, and most cases now occur in adults.

Deaths from epiglottitis are also rare, occurring in less than 1 in 100 cases.
feeling sick
nerve damage

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