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Epidural anesthesia is performed by the injection of a local anesthetic solution, with or without a narcotic medication, between the bones of the back outside of the fluid-filled spinal sac. The word epidural translates to "outside the dura". The dura is the outermost lining covering the nerves of the spinal column. Epidural anesthesia is achieved by injecting medications within this epidural space so as to target those nerves that supply the part of the body for which anesthesia/analgesia is desired. The actual inter-space chosen by your anesthesiologist will be based upon many considerations such as technical and anatomical factors. Often, a tiny, hollow, soft-plastic flexible catheter is positioned in the epidural space, and taped to the patient's back, to allow repeated or continuous doses of medications to be given. The catheter may be removed at the end of surgery, or sometimes days later if continued epidural medications are administered for postoperative pain control.
Local anesthetics, such as lidocaine or bupivicaine (Marcaine), given into the epidural space, bring on sensory and motor numbness. The anesthesiologist chooses the dose and type of drug depending on the patient's age, size, height, and the type of surgery. The addition of a narcotic solution may also be added to enhance the pain- controlling benefits of the epidural after the surgery is over.
Following the onset of numbness from epidural anesthesia, the patient may either stay awake for surgery, or more often intravenous sedation is given to achieve a light sleep. A lighter level of general anesthesia may also be required to supplement epidural anesthesia.
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