# Talk:Epidural administration

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I've heard a rumour that a tattoo on the lower back would prevent the giving of epidural infusion during child birth. Something to do with the fact of possible infections when the epidural needle passes through the tattoo (or near it).
Anyone have facts about this?

This article talks about "possible" neurological complications, but also says that no actual complications were found in the three cases they investigated: PMID 12477678.  In a comment on that article, PMID 1470947, Krzysztof M. Kuczkowski, MD of San Diego says:
Douglas and Swenerton first reported on the administration of labour analgesia in three parturients with lumbar tattoos and discussed the possible ramifications of neuraxial analgesia in women with tattoos in the lumbar area.1 All three women received uneventful epidural analgesia, and no anesthesia-related complications were reported. I herein present a similar case, and the first report of a minor anesthesia complication resulting from epidural needle insertion through tattoos during the performance of neuraxial block. A 34-yr-old, healthy female at term was in labour and requested labour analgesia. Preanesthetic back examination revealed the colourful tattoos covering her entire lumbar area. An epidural block was performed in a standard manner (one attempt at L2–3 interspace) with an 18-gauge Tuohy needle. Several hours after an uneventful delivery, the patient reported tenderness and burning in the lumbar area where the epidural catheter had been sited. Examination revealed a localized L2–3 interspace tenderness, however, due to the presence of a tattoo in this area, skin redness (irritation) could not be determined. The neurological examination was normal and her symptoms resolved over the next 24 hr. A pigment-containing tissue core from a tattoo seems a possible cause of deeper lumbar tissue irritation.
So it's clear that there's not a lot of research on this.  My inclination would be that this is the sort of thing anesthesiologists are trained to make professional judgments about, and the amount of research is thin enough that any comment by us one way or another on it is probably not worth it (by which I mean that we will more likely be confusing the reader than enlightening them.)  I won't oppose a completely neutral cite to this or other research if someone else thinks this is an important addition to the article, but if I was deciding entirely on my own I'd probably just leave it out.   Hope that helps, Nandesuka 13:00, 29 July 2005 (UTC)
In the "Side Effects" section it starts referring to childbirth, but nowhere before this in the article does it refer to childbirth.  This is somewhat confusing.  It actually refers to "fetal malpositions" which is even more confusing without referring in some way more specifically to childbirth.  Dawhitfield 22:30, 9 August 2005 (UTC)

Snopes has a good summary of the tattoo/epidural issue here. (In general, Canadian doctors are more concerned than American ones.) --Arcadian 22:35, 4 March 2006 (UTC)

Can someone who knows anything about this put together a comprehensive (or at least coherent) section on it?

Since over 50 years ago it was discovered that steroids injected epidurally can alleviate  spinal pain as well as limb pain. The exact mechanism is not fully understood but it is presumed to be due to a decrese in inflammation. Epidural steroid injection are, likewise in labor and delivery, for chronic pain injected in the epidural space.

Can anybody clarify the differences between a facet injection and a lumbar injection? Are they synonymous?

No. Vertebrae are held together by two kinds of joint. The main (load-bearing) joint is the rubbery intervertebral disc. However, there are also smaller synovial joints, called facet joints which link each vertebrae together. In certain diseases facet joints may become inflamed or painful, and injection of painkillers or anti-inflammatory medication into the synovial cavity of the facet joints may be performed. This treatment is designed to reduce pain and inflammation in one single facet joint only, and must be repeated for each involved joint (each vertebra has two). It is extremely fiddly, and not always possible, and doesn't always relieve pain.
For other types of back pain, an injection of anti-inflammatory medication (e.g. steroids) and painkillers may be performed into the epidural space (see main article). The types of pain treated and the types of injection performed are different in each case.
Preacherdoc 00:02, 1 June 2006 (UTC)Preacherdoc
For clarification- lumbar is the location of the body and facet is the part of the joint on the lumbar where the medication is given. For example, we have two choices to perform a series of three injections , in someone’s cervical area or in someones lumbar area. We then have a choice, depending on if there is radiculopathy present to perform a SNRB or Facet epidual injection. No Radiculopathy present, the patient’s back hurts more than the neck, so we will first perform a series of three Lumbar Facet eipdural injections. Hope this helps.  Joanne1212 (talk) 01:57, 19 December 2017 (UTC)

Epidural anaesthetics are being increasingly used for hip replacement surgery, yet this page refers almost exclusively to their use in parturition; it would be helpful if indications were more generally discussed. MikeSy 17:58, 1 June 2006 (UTC)

Not quite "almost exclusively", but I agree; when I get a bit of time I will expand. Preacherdoc 09:29, 4 June 2006 (UTC)Preacherdoc.
Right! That's better. Unfortunately Wikipedia logged me off mid-edit, and the new version is anonymous. However, the "moderate rewrite" was done by me. I aimed to remove the bias towards childbirth, and generally tidy up what had become quite a scrappy article.Preacherdoc 18:16, 15 July 2006 (UTC)Preacherdoc

I added the following link to the article, but it was reverted without an explanation by User:Nandesuka. I think it's an excellent edition to the article and adds a different experience.

Wendy Bellissimo: Willow's birth - The designer's story of her epidural during the birth of her third child
70.53.2.189 17:18, 24 July 2006 (UTC)

Since there doesn't seem to be a problem or objection with this link, I re-added it. (This is the same person as above, with a different IP) 67.68.138.190 01:31, 27 July 2006 (UTC)

Under the section "Epidural analgesia in childbirth" it mentions a study done in part by the University of Ontario in 2002. The link goes to the University of Ontario Institute of Technology which I know is incorrect. I attend UOIT and we have definitely never done a study on childbirth.....in fact, we had no students in 2002. The university is the newest in Canada and only began admitting undergrads in September 2003. It just started a graduate program in September 2006. Perhaps this is meant to be the University of Western Ontario? Cordova94 13:13, 26 October 2006 (UTC)

When my leg was operated with a spinal anesthesia, I was told by anethesiologist that he gives me 2 "shots".

the first shot was pianful,
the second one was just a pressure, following by
complete shutdown of the legs.
Could you please, deterimine which part of this writing is pertaining to a first shot, and second shot.
You will firnd yourself how to wikify, and format a clean distinction between 2 shots. THANKS

Since I don't know what your anesthesiologist did, I cannot explain what he did.  He might have performed a standard epidural injection, for which the "first shot" would refer to a infiltrative injection of a local anesthetic (probably lidocaine) to initially numb the area followed by a "second shot," referring to the large-bore needle used to insert the epidural catheter.
If your anesthesiologist performed a spinal block injection in conjuction with the epidural catheterization, the "first shot" above was probably not mentioned, and rather referred to the spinal injection.  This second explanation doesn't exactly fit well, because both the spinal and epidural procesures are performed with one stick of a needle, and so the epidural catherization wouldn't really be characterized as a "second" shot.  However, if you claim that the second shot was followed immediately (word and emphasis inserted by me) by leg motor and sensory shutdown, it is highly unlikely, nay, almost impossible for you to have received a standard epidural without a spinal component, because epidural placement of local anesthetics do take about 15 minutes to kick in.  Then again, you didn't say immediately (I did), and if you didn't intend to suggest it, perhaps I am speculating that you meant it. DRosenbach (Talk | Contribs) 00:23, 11 January 2008 (UTC)
I need to point out that Wikipedia is not the place to ask or reply to personal questions of a medical nature like this one. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

Is there such a thing as "Saddle Block"? Is this a common or slang term for "Caudal Anesthesia"? I have heard this mentioned as though it's an "alternative" to an "epidural"... can someone shed some light on this? If so perhaps there is value in adding it to the page.  —Preceding unsigned comment added by 70.241.106.73 (talk) 09:31, 27 December 2007 (UTC) 
A saddle block is a special case of a subarachnoid (spinal) anesthetic.  A caudal block is a special case of an epidural anesthetic.  There is some overlap in their uses, but the deposition of drug is anatomically distinct in the two approaches.  —Preceding unsigned comment added by Dkazdan (talk • contribs) 03:01, 6 February 2008 (UTC) 

The History section is very informative. However by stating that the development of the epidural procedure led to "a safe and painless method of childbirth" it makes the false assumption that previously all births were (a) unsafe and (b) always painful. See Ina_May_Gaskin and related links for more background.  —Preceding unsigned comment added by 121.44.91.233 (talk) 12:35, 4 January 2008 (UTC) 

This article is poorly written, or at least contains sections that are poorly written, thereby reflecting poorly on the entire article and calling its authority into serious question.  Drug names are misspelled (i.e. ropivicaine vs. ropivacaine) -- who is writing this, if not someone familiar with anesthesiology?
The section detailing the steps of an epidural catheterization included, prior to my minor editing, false information regarding both the physiologic entities traversed during catheterization, as well as misleading and confusing information regarding landmark/suggestive incidents that help the anesthesiologist perform the epidural catheterization.
Specifically, the "pop" occurs when an anesthesiologist pierces the dura (and the arachnoid), proceeding into the CSF-filled cavity known as the subarachnoid space with the much smaller gauge spinal needle, rather than accidentally proceeding too far with a Tuohy needle during an epidural.  The pop is certainly not associated with piercing of the ligamenta flavum.  My textbook (Basics of Anesthesia, Stoelting) makes no mention of "popping" when a Tuohy is advanced too far, but maybe yours does. DRosenbach (Talk | Contribs) 00:49, 11 January 2008 (UTC)

Well, you're about half right. Actually the flavum has an embryological midline defect. This means that if you are absolutely in the midline, you don't notice the pop as you go through it. However, the flavum is made of much denser tissue even than the interspinous ligament, and there is commonly both a noticeable increase in resistance as you traverse it, and a palpable pop when you breach it.
There is also a pop when you puncture the dura, with either a Tuohy needle or a pencil-point spinal needle.
Having rewritten the article considerably, I now hope you are more satisfied with it. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

Somebody has gone to a great deal of time and trouble to create a diagram, "Epiduraldiagram.png", which is wrong in many fundamental respects. For example, the pia mater is almost microscopically thin in life; here it is a thick layer. All of the spaces and structures are out of proportion. The epidural space is presented as an irregular space, when in fact it is quite regular in shape throughout. The bones as drawn here are reminiscent of vertebral bodies, although the part of the vertebra which should be here is the spinous process, whose shape is very different. The bones do not impinge on the epidural space the way they are shown. The ligamentum flavum (a lot bigger and more important than the pia!) is absent. As a means of illustrating the relationship of the epidural space to surrounding structures, this diagram, in my opinion, contains more that is wrong than right. Preacherdoc (talk) 16:59, 17 April 2008 (UTC)

There's lots of talk about layers and locations in the basic description of the procedure. This is extremely confusing to me. There is a diagram, but it's entirely useless as it lacks labels, and apparently it's inaccurate as well? Poor show. 94.193.253.59 (talk) 21:36, 31 August 2011 (UTC)

Related stubs that may merit being merged into this article.  Note that they conflate analgesia and anesthesia. --Una Smith (talk) 14:16, 10 May 2008 (UTC)

Combined spinal and epidural anaesthesia
Spinal analgesia
I am thinking Epidural should be a disambig, linking to Epidural space and Epidural (technique), among others.  Epidural (technique) would contain most of the content of the current Epidural.  That may help to encourage linking text that conveys more precise meanings, like this:  ... [[Epidural (technique)|epidural]] [[analgesia]].... --Una Smith (talk) 14:16, 10 May 2008 (UTC)

I really, really, really don't think we should arbitrarily separate epidural analgesia from epidural anaesthesia. This is not "conveying more precise meanings", but trying to artificially separate two things which overlap considerably. I can just about accept the case for making "Epidural" a disambig page with links to other topics, but I think (as above) that this makes the article "Epidural" less useful, since all the other topics associated with epidural are covered, appropriately, within the existing article. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)
I am not suggesting epidural analgesia and epidural anesthetic be separate articles;  I think those topics belong together in one article. --Una Smith (talk) 01:46, 11 May 2008 (UTC)
Sorry, Una Smith. I misinterpreted your previous remark. Preacherdoc (talk) 11:02, 11 May 2008 (UTC)

I've done a bit of a rewrite this evening. This article is (IMHO) much better laid out and contains many more references (there are loads still to add but I am starting to see double). Much of the criticism above has been addressed (I hope).
The article is now pretty long and probably needs to be split rather than merged with anything. You could always merge Combined spinal and epidural anaesthesia with Spinal analgesia. Both are pretty weak articles as they stand and could use a little propping up. That said, I would oppose that merge, since they are technically quite distinct techniques.
I still think (see my comments above) that the anatomy section of this article is completely worthless; I haven't even touched it.
I also think that there is a lot about epidurals in childbirth (including a pretty long discussion of potential harms and benefits) which could profitably be split out to a new article (e.g. Epidural analgesia in childbirth) or similar.
Finally, the History section was pretty windy and full of POV; I have tried to condense it down, but it really isn't all that great (nor, perhaps, relevant). It belongs in the non-existent History of regional anaesthesia article. Preacherdoc (talk) 21:43, 10 May 2008 (UTC)

The "Effects on the Baby" section looks pretty shoddy. Broken footnotes, phrase like "a noticable lack" and things like that. It looks like someone tried to edit it with a chainsaw and crayons. 24.155.174.23 (talk) 23:22, 24 April 2011 (UTC)

To be brought up to wikipedia's quality standards would anyone else be in favor of 
changing the title of the subsection known as Bolus or infusion? 
... the question mark appears unprofessional. I think it warrants a different title. Briwivell (talk) 00:30, 29 February 2012 (UTC)
There was a med error in the hospital. A young woman had an epidural for pain control post surgery and a bag of heparin was accidentally hung at 8u/hr.  Her hptt was normal after getting 34 hrs of medicine injected and her INR was 1.6.  She did not develop a hematoma but did display pain and it was not found during those times but until the bag ran out.  — Preceding unsigned comment added by 67.172.14.90 (talk) 13:32, 31 March 2012 (UTC) 

I reverted the removal of potential risks. The reliable reference included (Cochrane) does list these as risks. jsfouche ☽☾Talk 23:01, 16 September 2012 (UTC)

This is the kind of article that gives Wikipedia a bad name.  Instead of saying what epidural is, it talks all around it in the introduction.  Tehcnical stuff is fine -- but first just tell the reader what the subject is.  211.225.33.104 (talk) 06:26, 5 September 2013 (UTC)

Term not explained in article. 109.157.79.50 (talk) 23:54, 3 February 2015 (UTC)

This subsection(?) appears to have been haphazardly tacked on to the "Complications" section, it contradicts claims made earlier in the article, and it has generally poor spelling, clarity, and organization.
The first bullet point seems to indicate that "epidural anaesthesia and analgesia significantly slows the second stage of labour" is a controversial claim; however, "Longer delivery (second stage of labour)" was listed in the Advantages/Disadvantages chart (derived from a Cochrane review of studies relating to using epidurals for childbirth) in the "Epidural analgesia during childbirth" section earlier in the article.  It may be that the hypotheses for why this is the case - rather than whether it is the case - are controversial, but this distinction is not clearly indicated.
The wording of the second main bullet point (regarding the effects of the reclined position of the woman) is vague enough that I am not at all certain of what it's trying to communicate.  Perhaps that it is plausible that the woman assuming a reclined position could have an effect on the fetus?  If so, what effect is being discussed?  Also, while I'm not a seasoned Wikipedia editor, "plausible" doesn't seem like a word that should be used; the definition is far too imprecise.
The third main bullet point (regarding the rate of Caesarean sections after epidural analgesia administration) cites the Cochrane review mentioned earlier in this article to argue that women undergoing epidural analgesia during childbirth do not have a significantly higher rate of Caesarean-section delivery compared with those who do not undergo epidural analgesia.  Unlike the following paragraph, this statement fails to acknowledge that said review is comprised primarily (33 out of 38) of studies that only compare Caesarean rates between childbirths involving epidural analgesia and childbirths involving opiates as non-epidural analgesia; furthermore, the abstract does not distinguish its comparisons of epidural analgesia vs non-epidural analgesia from its comparisons of epidural analgesia vs no analgesia.  Based on this, it seems wiser not to make a sweeping statement.
Should this section be removed entirely or rewritten?  As mentioned above, I am no Wikipedia veteran, so I didn't want to commit an editing faux pas.  TheRollingMan (talk) 20:46, 9 June 2015 (UTC)

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Hello,
I am a fourth year medical student, and I am hoping to improve the content on this Wikipedia page in the coming weeks. I hope to address the following in my updates to the page:
1) I would like to provide better organization of headers more closely following WikiProject guidelines:
Difference from spinal anesthesia
Indications
Contraindications
Side effects
Complications
Anatomy
Technique (avoid step-by-step instructions)
Special situations
History (e.g., when it was invented)
2) I would like to add a section on contraindications, as indications are mentioned without the contraindications.
3) I hope to find additional sources for the anatomy section in order to prove its value.
4) In the later half of the technique section, I would like to expand the subheadings to distinguish how and why you choose certain techniques and options.
5) I would like to find sources to confirm information written in the "side effects" section. Additionally, this section could benefit from organizational and formatting changes.
6) I hope to expand the "history" section depending on the depth of information that is available as to include more dates and significant activities.
I am excited to begin making these changes and updating the content on this page to better describe the topic. Please let me know if you have any advice or corrections that you believe should be made to either my plan or the original Wikipedia page.
Thanks for the help,
Cwwweeden (talk) 03:11, 25 October 2018 (UTC)
Excellent job on providing some more organization and adding content to this article. In response to some of your changes: 
-The contraindications section is well organized, concise and provides a good overview.
-The anatomy section is well written and does a good job of giving a simple explanation of the relevant anatomy. If you can find a picture or diagram of this to help readers get a better visualization of the epidural space.
-Great job on expanding on this "technique" section and citing appropriate sources
-The side "effects" section flows well and is easy to read. Good job on providing sources for all of your content
Kz0190 (talk) 21:34, 14 November 2018 (UTC)

I'm removing the following content for being uncited as of now, but will try to reincorporate it if I can find sources - please feel free to add sources here and/or readd it into the article with sources:

Thanks, -bɜ:ʳkənhɪmez (User/say hi!) 06:30, 12 September 2020 (UTC)

"Loss of Resistance" redirects to this Epidural administration page, I believe incorrectly (or at least misleadingly) as "loss of resistance technique" is not specific to epidurals. 
As an example of the incorrect redirect, I arrived at this page by following the  "loss of resistance technique" link on the Fascia iliaca block page.
The only description of the technique in this article is in the Epidural administration#Insertion section: "Along with a sudden loss of resistance to pressure on the plunger of the syringe, a slight clicking sensation may be felt by the operator as the tip of the needle breaches the ligamentum flavum and enters the epidural space." Information which is very specific to epidurals.
I think "loss of resistance technique" should have its own page, but I am not remotely qualified to do this. Is there someone who is who could step in? Paxman (talk) 00:12, 6 April 2023 (UTC)