Editing Epidural administration (section)

== Uses ==
[[file:EDK Pump 1.jpg|thumb|upright|Epidural infusion pump with opioid ([[sufentanil]]) and anesthetic ([[bupivacaine]]) in a locked box]]

=== Pain relief during childbirth ===
Epidural injections are commonly used to provide pain relief ([[analgesia]]) during childbirth.<ref>{{cite journal |last1=Schrock |first1=SD |last2=Harraway-Smith |first2=C |title=Labor analgesia |journal=American Family Physician |date=1 March 2012 |volume=85 |issue=5 |pages=447–54 |pmid=22534222}}</ref> This usually involves epidural injection of a local anesthetic and [[opioid]]s, commonly called an "epidural". This is more effective than oral or [[Intravenous therapy|intravenous]] (IV) opioids and other common modalities of analgesia in childbirth.<ref name="Anim-Somuah2018">{{cite journal |vauthors = Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A |title = Epidural versus non-epidural or no analgesia in labour |journal = The Cochrane Database of Systematic Reviews |volume = 2018 |pages = CD000331 |year = 2018 |issue = 5 |pmid = 29781504 |pmc = 6494646 |doi = 10.1002/14651858.CD000331.pub4}}</ref> After an epidural is administered, the recipient may not feel pain, but may still feel pressure.<ref>{{cite journal |last=Buckley |first=Sarah |title=Epidurals: risks and concerns for mother and baby |journal=Midwifery Today with International Midwife |url=http://sarahbuckley.com/epidurals-risks-and-concerns-for-mother-and-baby#ref |publisher=Mothering No.133 |access-date=April 18, 2014 |date=2014-01-24 |issue=81|pages=21–3, 63–6 |pmid=17447690}}</ref> Epidural [[clonidine]] is rarely used but has been extensively studied for management of analgesia during labor.<ref name=Patel1996>{{cite journal |vauthors=Patel SS, Dunn CJ, Bryson HM |s2cid=72544106 |title=Epidural clonidine: a review of its pharmacology and efficacy in the management of pain during labour and postoperative and intractable pain |journal=CNS Drugs |year=1996 |volume=6 |issue=6 |pages=474–497 |doi=10.2165/00023210-199606060-00007}}</ref>

Epidural analgesia is considered a safer and more effective method of relieving pain in labor as compared to intravenous or oral analgesia. In a 2018 [[Cochrane Collaboration|Cochrane review]] of studies which compared epidural analgesia with [[oral administration|oral]] opioids, some advantages of epidural analgesia versus opioids included fewer instances of [[naloxone]] use in newborns, and decreased risk of maternal hyperventilation.<ref name="Anim-Somuah2018" /> Some disadvantages of epidural analgesia versus opioids included longer labor durations, an increased need for [[oxytocin]] to stimulate [[uterine contraction]]s, and an increased risk of fever, low blood pressure, and muscle weakness.<ref name="Anim-Somuah2018" /> 

However, the review found no difference in overall Caesarean delivery rates between epidural analgesia versus no analgesia. Additionally, there was no difference found on the immediate neonatal health of the child between epidural analgesia versus no analgesia. Furthermore, the occurrence of long-term backache was unchanged after epidural use.<ref name="Anim-Somuah2018" /> Complications of epidural analgesia are rare, but may include headaches, dizziness, difficulty breathing and seizures for the mother. The child may experience a slow heartbeat, decreased ability to regulate temperature, and potential exposure to the drugs administered to the mother.<ref>{{cite web |title=Anesthesia |url=http://search.credoreference.com/content/entry/hupwh/anesthesia/0?searchId=9b195ee2-c732-11e3-b874-0aea1e3b2a47&result=1 |publisher=Harvard University Press |access-date=April 18, 2014}}</ref>

There is no overall difference in outcomes based on the time the epidural is administered to the mother,<ref name="Cochrane2014">{{cite journal |vauthors=Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, Chan ES, Sia AT |title = Early versus late initiation of epidural analgesia for labour. |journal = The Cochrane Database of Systematic Reviews |volume = 2014 |issue = 10 |pages = CD007238 |date = October 9, 2014 |pmid = 25300169 |doi=10.1002/14651858.CD007238.pub2|doi-access = free |pmc = 10726979 }}</ref> specifically no change in the rate of caesarean section, [[Childbirth#Management|birth which must be assisted by instruments]], and duration of labor. There is also no change in the [[Apgar score]] of the newborn between early and late epidural administration.<ref name="Cochrane2014" /> Epidurals other than low-dose ambulatory epidurals also impact the ability of the mother to move during labor. Movement such as walking or changing positions may help improve labor comfort and decrease the risk of complications.<ref name=Lothian2009>{{cite journal |vauthors = Lothian JA |title = Safe, healthy birth: what every pregnant woman needs to know |journal = J Perinat Educ |volume = 18 |issue = 3 |pages = 48–54 |year = 2009 |pmid = 19750214 |pmc = 2730905 |doi = 10.1624/105812409X461225 }}</ref>

=== Pain relief during other surgery ===
Epidural analgesia has been demonstrated to have several benefits after other surgeries, including decreasing the need for the use of oral or systemic opioids,<ref name=Block2003>{{cite journal |vauthors=Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA, Wu CL | s2cid = 35260733 | title = Efficacy of postoperative epidural analgesia: a meta-analysis | journal = JAMA | volume = 290 | issue = 18 | pages = 2455–63 | year = 2003 | pmid = 14612482 | doi = 10.1001/jama.290.18.2455 }}</ref> and reducing the risk of postoperative respiratory problems, chest infections,<ref name=Ballantyne1998>{{cite journal |vauthors=Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F | s2cid = 37136047 | title = The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials | journal = Anesth Analg | volume = 86 | issue = 3 | pages = 598–612 | year = 1998 | pmid = 9495424 | doi = 10.1097/00000539-199803000-00032 | doi-access = free }}</ref> [[blood transfusion]] requirements,<ref name=Allman1038/> and [[myocardial infarction]]s.<ref name=Beattie2001>{{cite journal |vauthors=Beattie WS, Badner NH, Choi P | s2cid = 9449275 | title = Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis | journal = Anesth Analg | volume = 93 | issue = 4 | pages = 853–8 | year = 2001 | pmid = 11574345 | doi = 10.1097/00000539-200110000-00010 | doi-access = free }}</ref> Use of epidural analgesia after surgery in place of systemic analgesia is less likely to decrease [[intestinal motility]] which would occur with systemic opioid therapy through blockade of the sympathetic nervous system.<ref name="Allman1038">{{cite book|title=Oxford handbook of anaesthesia|vauthors=Wilson IH, Allman KG|publisher=Oxford University Press|year=2006|isbn=978-0-19-856609-0|location=Oxford|page=1038}}</ref><ref name=Gendall>{{cite journal |vauthors=Gendall KA, Kennedy RR, Watson AJ, Frizelle FA | title = The effect of epidural analgesia on postoperative outcome after colorectal surgery | journal = Colorectal Disease | volume = 9 | issue = 7 | pages = 584–98; discussion 598–600 | year = 2007 | pmid = 17506795 | doi = 10.1111/j.1463-1318.2007.1274.x }}</ref> Some surgeries that spinal analgesia may be used in include lower abdominal surgery, lower limb surgery, cardiac surgery, and perineal surgery.<ref name="Allman1038" /><ref>{{cite journal|last1=Guay|first1=Joanne|last2=Kopp|first2=Sandra|date=2019-03-01|title=Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass|journal=The Cochrane Database of Systematic Reviews|volume=2019|issue=3 |pages=CD006715|doi=10.1002/14651858.CD006715.pub3|issn=1469-493X|pmc=6396869|pmid=30821845}}</ref><ref>{{cite journal|last1=Salicath|first1=Jon H.|last2=Yeoh|first2=Emily Cy|last3=Bennett|first3=Michael H.|date=2018-08-30|title=Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults|url=|journal=The Cochrane Database of Systematic Reviews|volume=8| issue=10 |pages=CD010434|doi=10.1002/14651858.CD010434.pub2|issn=1469-493X|pmc=6513588|pmid=30161292}}</ref>
[[File:Epidural kit in sterile packaging.jpg|thumb|A single-use epidural administration kit in sterile packaging]]

=== Others ===
{{Main|Epidural steroid injection|Epidural blood patch}}

The injection of steroids into the epidural space is sometimes used to treat [[radiculopathy|nerve root pain]], [[radicular pain]] and [[inflammation]] caused by conditions such as [[spinal disc herniation]], [[degenerative disc disease]], and [[spinal stenosis]].<ref name="episteroid" /> The risk of complications from steroid administration is low and complications are usually minor. The specific drug, dose, and frequency of administration impacts the risk for and severity of complications. Complications of epidural steroid administration are similar to the side effects of steroids administered in other manners, and can include higher than normal blood sugar, especially in patients with [[type 2 diabetes]].<ref name="episteroid" />
An [[epidural blood patch]] consists of a small amount of a person's own blood is injected into the epidural space. This is done as a method of sealing a hole or leak in the epidural.<ref name="auto">{{Citation|last1=Tubben|first1=Robert E.|last2=Murphy|first2=Patrick B. |title=Epidural Blood Patch |date=2018 |url= https://www.ncbi.nlm.nih.gov/books/NBK482336/ |work=StatPearls|publisher=StatPearls Publishing|pmid=29493961|access-date=2018-10-31 }}</ref> The injected blood clots at the site of the puncture, closes the leak, and modulates CSF pressure.<ref>White, Benjamin; Lopez, Victor; Chason, David; Scott, David; Stehel, Edward; Moore, William (2019-03-28). [https://www.appliedradiology.com/communities/MR-Community/the-lumbar-epidural-blood-patch-a-primer The lumbar epidural blood patch: A Primer.] ''Applied Radiology''. '''48''' (2): 25–30.</ref><ref>{{cite journal|last1=Nath|first1=Gita|last2=Subrahmanyam|first2=Maddirala|date=2011|title=Headache in the parturient: Pathophysiology and management of post-dural puncture headache|url=http://www.joacc.com/text.asp?2011/1/2/57/93988|journal=Journal of Obstetric Anaesthesia and Critical Care|language=en|volume=1|issue=2|pages=57|doi=10.4103/2249-4472.93988|issn=2249-4472|doi-access=free}}</ref>  This may be used to treat [[post-dural-puncture headache]] and leakage of [[cerebrospinal fluid]] due to dural puncture, which occurs in approximately 1.5% of epidural analgesia procedures.<ref name=":0">{{cite journal|vauthors=Silva M, Halpern SH|date=2010|title=Epidural analgesia for labor: Current techniques|journal=Local and Regional Anesthesia|volume=3|pages=143–53|doi=10.2147/LRA.S10237|pmc=3417963|pmid=23144567 |doi-access=free }}</ref>