While epidurals are generally safe, they still carry a degree of risk and some side effects, including headache, soreness, and a decrease in blood pressure. In rare situations, they may also result in long-term complications.

An epidural is a method of pain relief that a person receives as an injection in their lower back. The medication is a nerve blocker and can be useful during labor, childbirth, and some types of surgery. It is a type of regional anesthetic that causes a loss of sensation, especially around the abdomen or pelvic region.

In this article, we will explore how a healthcare professional may administer an epidural, as well as the risks, side effects, and potential complications of an epidural.

An image of a person in labor.Share on Pinterest
Layland Masuda/Getty Images

An epidural, also known as an epidural block, is a type of regional anesthetic. An anesthetic is a medicine that helps prevent a person from experiencing pain. A regional anesthetic describes a medicine that causes a loss of feeling in a large part of the body, such as from the waist down.

The place the numbness occurs can vary depending on the placement and type of epidural a doctor uses. For example, in the case of an epidural for labor, it creates a band of numbness from the belly button to the upper legs.

The name comes from the injection site of the medication, as a doctor injects it into the epidural space. This area refers to the space between the dura mater or dural membrane, which is a tough layer of protective tissue, and the spinal cord. This medicine can help prevent pain by blocking the nerves in the spinal cord that would usually send a signal to the brain to register pain.

A doctor may consider using an epidural in surgical procedures such as spine and abdominal surgeries and during childbirth and delivery.

During childbirth, an epidural administration will usually involve a catheter. This is a small tube that a healthcare professional inserts into the lower part of the back using a needle. After removal of the needle, the catheter remains in place to deliver the medicine through the tube. The person receiving the epidural will still be awake and alert during childbirth but will have some loss of feeling and pain in the lower part of their body.

Before the epidural administration, the healthcare professional will typically numb the injection area with a local anesthetic. A local anesthetic is a type of medicine that numbs a small area of the body. There may be a small pressure or tingling sensation during the injection. However, after injection of the epidural, there should be very little pain. A person may still feel some pressure with the insertion of the needle.

The anesthesia team will attempt to provide a person giving birth with pain relief for as long as necessary. Typically, after the first 48–72 hours, they may try to transition to oral pain medications and discontinue the epidural catheter.

However, not every person will require an epidural, and they can discuss their options with the anesthesia care team. In fact, some people may not be a suitable candidate for an epidural. This may include individuals with bleeding disorders, those currently taking blood thinners, or those with a history of spine or brain problems.

For other procedures, such as surgeries or treatment for pain, a person may receive an epidural via a single injection using a needle. People will typically obtain pain relief within minutes, but it may take a while to adjust the dose for optimal pain relief.

People can also combine both methods and receive a combined spinal-epidural. This provides quick pain relief that the anesthesia team can maintain through the epidural catheter.

Epidurals are very effective at relieving pain, with only about 1 in 100 people requiring supplementary pain-relief medication during labor. However, there are still some risks and side effects that may occur with an epidural.

Side effects of epidurals may include:

  • A decrease in blood pressure: A person may experience a decrease in their blood pressure after epidural administration. During childbirth, this may slow the baby’s heart rate. To reduce the likelihood of this occurring, a person may receive extra fluids and may need to lie on their side.
  • A sore back: A person may feel some soreness at the injection site. This soreness does not usually last more than a few days.
  • Headache: Rarely, the epidural injection may puncture the protective layer of the spinal cord. This is known as a dural puncture. This may occur in 2–3% of cases and can cause spinal fluid to leak out, resulting in a headache.
  • Itchiness: When using opioids, it is common for a person to experience itching. A person may be able to treat this itchiness with other medication.
  • Numbness and tingling in the legs: A person may experience their legs feeling heavy. Additionally, people may feel weakness in their legs.
  • Problems with urination: A person may require a urinary catheter if they experience difficulty urinating after an epidural.

Other less common side effects may include:

  • nausea
  • vomiting
  • breathing problems
  • fever
  • infection, such as meningitis
  • epidural hematoma
  • epidural abscess
  • osteomyelitis
  • sepsis

Evidence states that an epidural poses very little risk to a baby. However, it may increase the risk of a baby experiencing short-term changes. These can include:

  • changes in heart rate
  • problems with breathing
  • tiredness
  • a decrease in muscle tone
  • a decrease in breastfeeding

According to the American College of Obstetrics and Gynecologists, serious complications with epidurals are very rare. However, potential long-term complications can include:

  • permanent injury to the spinal cord or nerves
  • breathing problems
  • persistent numbness or tingling

While the injection site and labor itself can cause back pain, it is very unlikely that an epidural will cause long-term back pain. And while it is not impossible, evidence suggests that permanent nerve damage is very unlikely, as it accounts for fewer than 1 in 240,000 cases.

Some sources also suggest a link between an epidural and autism in children. However, studies in Canada and Denmark highlight that there is no association between epidural exposure and autism spectrum disorder in children.

If a person is worried about the side effects or risks of an epidural, they should speak with their healthcare professional regarding their treatment options.

An epidural is a type of regional anesthetic that can help relieve pain from below the waist. A doctor may use it during surgical operations and to assist with childbirth and delivery. A healthcare professional will typically administer an epidural by injecting a catheter into the back using a needle. Some procedures, such as small surgeries or treatment for pain, may only require an epidural injection with a needle.

Potential side effects of an epidural may include headache, soreness, urination problems, and a decrease in blood pressure. While long-term complications are extremely rare, they may result in permanent nerve damage and persistent numbness and tingling.