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What Is an Epidural Needle?

A sacral epidural allows a patient to remain conscious and aware while effectively controlling pain.
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  • Written By: V. Cassiopia
  • Edited By: Angela B.
  • Last Modified Date: 17 December 2014
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An epidural needle is a needle used in a nonsurgical procedure to inject an anesthetic and/or medication into the epidural space of the spine. That space is between the vertebrae — the bones of the spinal column — and the dura mater, a thick membrane covering the spinal cord. It is similar to a hypodermic needle in that it has a hallow core; however, while a hypodermic needle has a straight, sharply piercing tip, the epidural needle has a tip that is curved, blunt, and slightly splayed. While each type of needle can be attached to a plastic or glass syringe with volume markings in cubic centimeters (cc), an epidural needle has length markings every 0.40 inch (1 cm) on the needle itself, to clearly show its depth of penetration.

In terms of length, an epidural needle is usually from about 3 inches (7.6 cm) to about 5 inches (12.7 cm). Epidural needle sizes are determined by the diameter of the needle lumen, or inner tube. Gauge sizing is designated in an inverse relationship, with larger gauge numbers indicating smaller needle diameters.

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Injections given with epidural needles are called “epidurals,” or “spinal blocks.” They are given most commonly for pain relief during childbirth or for back pain, in general. When given for back pain, a steroid such as cortisone can be added to the anesthetic to help reduce inflammation as well as pain. Pain control is produced when the medication reaches nerve roots in the epidural space and blocks them with dispersed anesthetic.

Placing an epidural injection requires adroit skill and knowledge of spinal anatomy to reach the necessary injection site without harming the spinal cord. For example, each vertebral level has a pair of nerve roots, and each nerve root exits on opposite sides of the spinal column through a bony opening called a foramen. It is necessary for the epidural needle to enter through the foramen next to the nerve root to be anesthetized without accidentally piercing the spinal dura, which can cause severe complications.

Fluoroscopy, a form of X-ray, is commonly used to aid a radiologist or other medical specialist in guiding the epidural needle during an injection. This helps to identify the epidural parts and avoid the serious complications that can result from puncturing the spinal cord membranes. Fluoroscopy can also help identify whether the epidural space is “segmented,” such as by development of fibrous bands associated with aging, which can make epidural injections more difficult without the aid of this visualizing equipment.

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JimmyT
Post 8

@jmc88 - Since I have never given birth, I'm not really sure what the whole process is like, but I have talked to a lot of people about their experiences with having kids. From what I can tell, maybe epidurals are just more for C-sections and surgeries. I still think they can give mothers other types of pain relievers, though. I have heard plenty of stories about people giving birth and feeling the effects of the pain killers afterward.

I'm not sure what they give them, though. It seems like it would be hard to do most IV pain relievers like morphine, because that would be transferred to the child possibly. Maybe it happens quickly enough that transfer isn't a problem. I'm not sure.

Does anyone here have any idea what the rate of complications from epidurals is in terms of either hitting part of the spinal column or whatever else could happen? Just curious whether the risk is worth the reward.

jmc88
Post 7

@kentuckycat - Good question. When my wife was having birth, she got an epidural, and I noticed that the needle was curved, so I asked the doctor about it. Apparently, it is called a Tuohy needle and has the curved end so that it doesn't "core out" any of the spinal material. As he described it to me, if it didn't have the curved tip, it would kind of be like putting a straw into a milkshake and then putting your finger over the top and pulling it out with the liquid inside. Since they want all the fluid to stay in the body, they added to curve to stop that from happening.

My wife also had a C-section, but do they also give epidurals for normal births? Like someone else mentioned, people have been giving birth for a long time without any pain relievers, so it is obviously not a necessity. Just another option to make the process less stressful on the mom, I guess.

kentuckycat
Post 6

@titans62 - I was with you. I was never really sure about the specifics of an epidural. I thought this cleared it up nicely. I decided to look up an epidural needle picture, and after seeing it, I'm not sure I would want one unless I was in some serious pain. Then again, I'm not really a fan of needles and syringes, anyway.

While I was looking at the picture, I read a little bit about the history. Apparently, epidurals have been around for a little over a hundred years, but have only been used for childbirth since the 1940s. Like you guessed, the first uses weren't for childbirths. The first time it was used for that was in an emergency. Eventually it became a standard practice for cesareans.

The one question I still have though, is why the needle is curved. I can't quite figure that one out. It seems like you would be easier to steer the needle straight in.

titans62
Post 5

I always hear people talking about epidurals, but I never really knew what they were. I just knew it was something that mothers usually got during childbirth and that it was supposedly painful. From the comments here, I guess that sounds about right.

Whenever I read about medical procedures like this, it always makes me wonder how many people were "experimented" with before they started to perfect the process. I have a feeling the original use of epidurals wasn't for childbirth, though.

Does anyone have any idea when the procedure first came about? My guess would be that they created the process for relieving severe back pain or for surgeries or something. I doubt a lot of expecting mothers would have signed up to test a new idea of getting a big spinal needle put in their back just to reduce the amount of pain. I guess it is good to know that there is an option to relieve pain, but then again, women have been giving birth for thousands of years without anesthesia.

dfoster85
Post 4

During my lengthy labor with my first child, I had an epidural. These have become almost standard, but I'm not sure why they are the first choice for so many people. First of all, the position you have to get in is very uncomfortable. Then you have to lie flat on your back waiting for it to take effect. That was truly, truly painful. And for me, it was fruitless waiting - the first one didn't take at all. I think perhaps the nurse anesthetist had missed the spot.

So they got the anesthesiologist in there and I finally got some relief - two hours after I first asked for it! Let me tell you, it was a *long* two hours. All moms should be prepared with other pain relief strategies just in case, even if you plan to have an epidural.

Other not-so-fun side effects were that I threw up during one of them (the first, I think) and that spot on my back was sore on and off for months afterwards. I'm not saying don't get an epidural - just that people should realize that they have downsides and aren't a sure way to a pain-free childbirth.

discographer
Post 3

@burcinc-- The only side effect I've heard about from epidural anesthesia is temporary back pain afterward. But usually it goes away in a short time period and is not serious or debilitating.

Of course, if there is any nerve damage that occurs as a result of having an epidural, there might be more serious side effects. Some that I've heard of is back, hip and or leg pain, numbness or tingling in leg or legs and difficulty walking. If there are symptoms like these, there could be spinal damage and it should be treated right away.

burcinc
Post 2

@anamur-- Wow, thanks so much for that information! I'm probably going to get an epidural during my cesarean and I asked my doctor about it but he didn't tell me much of the details.

I'm so happy that you described the procedure here. Do you know if epidural has side effects? Will I have pain in the injection area after the anesthesia wears off or any other types of side effects?

serenesurface
Post 1

My mom told me about epidural needles and epidural procedures before. She used to work as an anesthesiology technician before she became a teacher. She says that she's done epidurals many times for women who were having cesareans and for herniated disc surgeries.

I didn't understand why an epidural would be given during a cesarean but she explained it to me.

She said that a mother stays awake during the cesarean and instead of complete anesthesia, is given anesthesia to the epidural space with an epidural needle. It is a risky procedure and can only be done by very experienced technicians or doctors.

I asked my mom if the needle hurts and she said it does because it is much larger than a regular needle. But they also give local anesthesia before inserting the epidural needle so it doesn't hurt.

The next part she told me about was so interesting. She said that when the needle is in the epidural space, she would fill the needle with spinal fluid. Then, the anesthetic drug was added to the spinal fluid and pushed back into the epidural space.

The patient is not supposed to move while this is happening and then she has to be sitting up so that the anesthesia doesn't reach the throat. Once the person is numb, they start the cesarean. Woman who receive epidural are completely awake during the cesarean and talk while it's happening!

My mom said that women can feel the doctor touching her stomach, but she doesn't feel any pain. And she is wide awake when her baby is born and starts crying! But apparently, only really healthy women without complications in their pregnancy can be given an epidural during birth.

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