“Labor causes severe pain for many women. There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. Pain management should be provided whenever medically indicated. Of the various pharmacologic methods used for pain relief during labor and delivery, neuraxial anesthetic techniques (epidural, spinal, and combined spinal-epidural) are the most flexible, effective, and least depressing to the central nervous system, allowing for an alert participating woman and an alert neonate.” This is a joint statement from the American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG).
When the decision has been made for you to have a Labor Epidural, you will be visited by an Anesthesiologist. CRNA’s may assist the Anesthesiologist with your epdiural or may be monitoring the epidural after placement.
- Anesthesiologist (MD, DO Physician)
An Anesthesiologists is a physician who has completed a four-year residency in anesthesia in addition to medical school (4 years) and pre-medical school (4 years). Some Anesthesiologists will also complete a one (1) year Fellowship. Combined educational years are 12-13 years to become Anesthesiologists. They must pass extensive written and oral examinations as part of the credentialing process. They may supervise other types of providers such as CRNAs and AAs. All of our Anesthesiologist are Board Certified, or, are Board Eligible until Certified.
- Certified Registered Nurse Anesthetist (CRNA)
A CRNA is a registered nurse with a bachelor’s degree (BSN, 4 years of education). CRNA’s work in an ICU after obtaining their BSN. Then they go back to Nurse Anesthetist School and receive a master’s degree in the administration of anesthesia. Combined education years are approximately 6-7 years. Depending on the state, CRNAs may work independently or under the supervision of Anesthesiologists. Nebraska is an opt-out state so CRNA’s may provide anesthesia without supervision in the State of Nebraska. CRNA’s may not supervise other providers.
After you have met an anesthesia professional, they will proceed with providing a Labor Epidural by starting with a pre-evaluation of your personal and physical history and exam which in the medical term may also be called a “pre-op”.
- Pre-Evaluation
During your pre-op visit by our Anesthesia Professional, you will be asked questions about your health status, similar to a History and Physical. Pre-Epidural Evaluations are very important to determining the safety and efficacy of the Epidural your anesthesia professional will be providing you. In general this allows the anesthesia professional to determine risk factors and determine the proper care. Knowledgeable and honest personal health information given to the anesthesia professional are critical to patient safety in this evaluation as medical history, drug and other allergies, current medications as well as illegal drug use, alcohol and tobacco use are all factors in determining challenges to Epidural placement. It is very important to notify the anesthesia professional if you are taking any drugs for anticoagulation. A physical examination may also be performed.
- NPO
You will have been instructed by your surgeon (or surgical facility or both), prior to the date of surgery the importance of NPO. This is a Latin term for Nil Per Os meaning Nothing by Mouth. Those in medicine agree that because of risk of aspiration during surgery, food and liquid should be avoided prior to an operation. A rule of thumb is to begin abstaining eight (8) hours prior to the procedure however allowances should be made for young children and those taking certain medications. NPO orders of your surgeon, facility and anesthesia professional should always be followed closely and it is very important that you notify your anesthesia professional the exact time you last ate or drank anything by mouth.
- Informed Consent
This is a separate document the patient will be provided to read regarding the definitions of the type of anesthesia to be given, as well as the benefits and risks of anesthesia. Your anesthesia professional will go over the “informed consent” with the patient prior to surgery and discuss which type of anesthesia will be provided. The patient (or other legal caregiver) will be asked to sign this document which is a legal document that the patient has been informed of the risks and wishes to proceed with anesthesia.
Informed Consent Form
The term epidural (from Ancient Greek) is a simplified and all-inclusive term often used to refer to techniques such as epidural analgesia and epidural anesthesia. The epidural route is frequently employed by anesthesia professionals to administer diagnostic and therapeutic chemical substances, as well as certain analgesic and local anesthetic agents. Epidural techniques frequently involve injection of drugs through a catheter placed into the epidural space (back, in the vicinity of the spinal cord). The injection can result in a loss of sensation, including the sensation of pain, by blocking the transmission of signals through nerves in or near the spinal cord.
For analgesia alone, where surgery i
s not contemplated, an epidural injection or infusion for pain relief (e.g. in childbirth, labor epidural) is less likely to cause loss of muscle power, but is not usually sufficient for surgery.
However, some operations, most frequently Caesarean section, may be performed using an epidural anesthesic as the sole technique. Typically the patient would remain awake during the operation.
Spinal anesthesia is different from an Epidural. People often confuse these two techniques. Spinal anesthesia is a technique whereby a local anesthetic drug is injected into the cerebrospinal fluid, whereas an Epidural is injected into the epidural space. The two techniques do have some similarities. Spinals are often used for Caesarean sections.
Here are some differences between a Spinal and Epidural:
- An epidural injection may be performed anywhere along the vertebral column (cervical, thoracic, lumbar, or sacral), while spinal injections are typically performed below the second lumbar vertebral body.
- To achieve epidural analgesia or anesthesia, a larger dose of drug is typically necessary than with spinal analgesia or anesthesia.
- The onset of analgesia is slower with epidural analgesia or anesthesia than with spinal analgesia or anesthesia.
- It is easier to achieve segmental analgesia or anesthesia using the epidural route than using the spinal route.
- An indwelling catheter is more commonly placed in the setting of epidural analgesia or anesthesia than with spinal analgesia or anesthesia.
s not contemplated, an epidural injection or infusion for pain relief (e.g. in childbirth, labor epidural) is less likely to cause loss of muscle power, but is not usually sufficient for surgery.
