Worried About Incomplete Pain Relief With Epidural
by William Reid Camann, MD
Q. I have heard that sometimes the epidural does not completely block labor pain- my girlfriend told me after her epidural one side of her body was pain free- and the other still felt painful. How does that happen? Does this happen often?
This can happen with epidural anesthesia. The reason may be related to several factors. One possible reason is that some people have tissues, ligaments or other anatomical barriers within the epidural space that can prevent the anesthetic medications from spreading properly and anesthetizing all the nerves. If this happens, it can usually be fixed by giving additional doses of the anesthetic drugs, or sometimes by using different types of anesthetic medications. If this does not fix the problem, then slightly changing the position or even replacing entirely the epidural catheter to another space in your back may be recommended.
This can also happen because you have been lying on one side for a prolonged period of time. Gravity is one of the mechanisms that help the anesthetic drugs spread within the epidural space. Thus, you will generally be encouraged to move from side to side during labor to prevent this problem.
This is not a frequent occurrence. A one-sided block occurs in roughly 5-10% of all epidurals, and is almost always able to be fixed with the methods noted above. Your anesthesiologist and labor nurse will work with you to help determine exactly how to approach an epidural that is not working on both sides.
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