When your epidural works a little too well…
As you know I am a board-certified anesthesiologist. I spend a good portion of my clinical work in labor and delivery where I assist expectant mothers with pain management. Naturally with my first delivery, I got an epidural for labor pain control which worked well overall. I was excited to get another epidural with my second delivery. I expected things to go as planned, however they did not!
I got an elective induction at 39 weeks (like my first delivery) and received the typical induction meds, Misoprostol and Pitocin. When the Pitocin was started, my contractions got more significant and after a cervical check where I was dilated about 6cm, I decided to get my epidural. I ended up getting a combined spinal epidural (CSE) which means a small dose of the local anesthetic is injected in the cerebrospinal fluid and the typical epidural catheter is left behind for continued pain control. With a spinal injection, pain relief is almost immediate and significant. Shortly after the CSE however, I became extremely numb in both my legs. I couldn’t feel them, let alone move them. I felt like I was paralyzed from the waist down. At 2am in the morning, with my husband dozing on and off on the couch, I started having serious anxiety about not being able to move my legs. I asked for the epidural infusion rate to be lowered so that the numbness becomes left prominent. Usually with epidurals, one is supposed to not feel pain but should be able to move their toes and/or legs. After about an hour, the block in both of my legs continued to be dense, to the point where my legs felt ice cold. I couldn’t handle mentally being unable to move my legs and every time I woke up from sleep, I felt like I was paralyzed. I shortly had my very first panic attack. I was sobbing, my breathing got rapid and shallow while my heart rate shot up to 180! The nurse came running, my husband was holding my hand and talking to me to calm me down and my baby was having signs of distress on the monitor. After a few mins of calm redirection from the nurse and my husband, my breathing and heart rate came back to normal. I looked at the nurse in between my tears and said “We’re stopping the epidural, please call the anesthesiologist and tell him I need this off.” After stopping the infusion for an entire 1.5hr, my legs finally started to wake up. With that, the labor pain was also coming back. We therefore bolused (gave a single large dose) the epidural and restarted it at a much lower rate. Soon after, I was fully dilated and baby Kaleb arrived. The epidural was turned off and after nearly 8 full hours I was able to finally walk on my own without worrying about the numbness in my legs.
There are things I would like you to take away from this.
1. The difference between a spinal, combined spinal epidural and epidural
a. Spinal anesthesia —> the local anesthetic is injected in the cerebrospinal fluid. You get a dense block in both of your legs, you become numb from the waist down, you are unable to move your legs. Usually used in C sections, urology and/or lower extremity surgeries.
b. Combined spinal epidural anesthesia —> same as above + an epidural catheter is left in place to continue giving you the local anesthetic for pain control. You may be unable to move your legs depending on the dose given. Usually used in C sections, urology and/or lower extremity surgeries.
c. Epidural anesthesia —> the catheter is left in the epidural space. Onset of block or numbness takes a few mins. Typically you are able to move legs unless higher concentration and dose is used. Usually used in C sections, urology and/or lower extremity surgeries.
2. Measures you can take if you are too numb after your epidural. Ask the following:
a. Lower the infusion rate of the local anesthesia, you get less, you are less numb.
b. Turn it off, only if you are extremely numb and having a serious psychological impact like I did. We can always restart it and find a happy medium.
c. Change the infusion bag concentration to a less concentrated one so that the numbness is less
Always speak up for yourself in the hospital. Ask questions, seek to understand your medical treatment.
Until next time,
Dr. Beti <3