What are the advantages and disadvantages of epidural anesthesia?

Epidural anesthesia allows continual highly effective relief of labor pain, using only small amounts of medication deposited directly on the spinal nerves. With proper medication combinations and dose adjustments this pain relief can be achieved, optimally without losing the ability to control movement in any part of the body.

In some instances, however, variable reduction in strength or coordination of the legs does occur as a side effect. Most importantly, epidural anesthesia provides clearly superior pain relief, while having little of the sedating side effects that limit the use of the intravenous pain medications that were discussed above.

Also, if cesarean section becomes necessary, the epidural catheter that is already in place can be used to provide anesthetic for the cesarean delivery while the patient remains awake and comfortable. Disadvantages of epidural anesthesia include its potential for contributing to uncommon minor complications such as:

  • Persistent positional headache afterwards, that occasionally requires additional treatment for rapid resolution
  • Incomplete epidural nerve block allowing "patches" of discomfort during labor (sometimes requiring replacement of the catheter)
  • Low back discomfort at the location of the needle placement that is usually short lived and always is self limited.

A potentially more serious complication is excessive lowering of the patient's blood pressure that sometimes occurs immediately after the placement of the epidural. Fortunately, this side effect of epidural anesthesia can be avoided in most instances, and is remedied quickly and easily by the vigilant anesthesiologist.

In all other instances, very serious complications such as infection or bleeding into the confined epidural space, both of which could cause neurologic injury, have been reported but are extremely rare in the healthy obstetrical population.  The potential of local anesthetic toxicity is also very rare.