Editing Epidural administration (section)

===Medication-specific===
If bupivacaine, a medication commonly administered via epidural, is inadvertently administered into a vein, it can cause excitation, nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, or seizures as well as [[central nervous system depression]], loss of consciousness, respiratory depression and apnea. Bupivacaine intended for epidural administration has been implicated in cardiac arrests resulting in death when accidentally administered into a vein instead of the epidural space.<ref name="Rosenblatt2006">{{cite journal|vauthors = Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB |s2cid=40214528|year=2006|title=Successful Use of a 20% Lipid Emulsion to Resuscitate a Patient after a Presumed Bupivacaine-related Cardiac Arrest|journal=Anesthesiology|volume=105|issue=7|pages=217–8|pmid=16810015|doi=10.1097/00000542-200607000-00033|doi-access=free}}</ref><ref name="Mulroy2002">{{cite journal|author=Mulroy MF|year=2002|title=Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures.|journal=Reg Anesth Pain Med|volume=27|issue=6|pages=556–61|pmid=12430104|doi=10.1053/rapm.2002.37127|s2cid=36915462}}</ref> The administration of large doses of opioids into the epidural space may cause [[pruritus|itching]] and respiratory depression.<ref name="Jacobson1988">{{cite journal|vauthors=Jacobson L, Chabal C, Brody MC|year=1988|title=A dose-response study of intrathecal morphine: efficacy, duration, optimal dose, and side effects|journal= Anesthesia & Analgesia|volume=67|issue=11|pages=1082–8|doi=10.1213/00000539-198867110-00011|pmid=3189898|doi-access=free}}</ref><ref name="Wust1987">{{cite journal|vauthors=Wüst HJ, Bromage PR|year=1987|title=Delayed respiratory arrest after epidural hydromorphone|journal=Anaesthesia|volume=42|issue=4|pages=404–6|doi=10.1111/j.1365-2044.1987.tb03982.x|pmid=2438964|s2cid=37237552|doi-access=free}}</ref> The sensation of needing to urinate is often significantly diminished or completely absent after administration of epidural local anesthetics or opioids.<ref name=":2">{{cite journal|vauthors=Baldini G, Bagry H, Aprikian A, Carli F|date=May 2009|title=Postoperative urinary retention: anesthetic and perioperative considerations|journal=Anesthesiology|volume=110|issue=5|pages=1139–57|doi=10.1097/ALN.0b013e31819f7aea|pmid=19352147|doi-access=free}}</ref> Because of this, a [[urinary catheterization|urinary catheter]] is often placed for the duration of the epidural infusion.<ref name=":2" />

In many women given epidural analgesia during labor oxytocin is also used to augment uterine contractions. In one study which examined the rate of breastfeeding two days following epidural anesthesia during childbirth, epidural analgesia used in combination with oxytocin resulted in lower maternal oxytocin and prolactin levels in response to breastfeeding on the second day following birth.<ref name="Jonas2009">{{cite journal|vauthors=Jonas K, Johansson LM, Nissen E, Ejdebäck M, Ransjö-Arvidson AB, Uvnäs-Moberg K|year=2009|title=Effects of Intrapartum Oxytocin Administration and Epidural Analgesia on the Concentration of Plasma Oxytocin and Prolactin, in Response to Suckling During the Second Day Postpartum|journal=Breastfeed Med|volume=4|issue=2|pages=71–82|doi=10.1089/bfm.2008.0002|pmid=19210132}}</ref> The lower maternal oxytocin level negatively affects the baby’s feeding rooting reflex, decreasing the amount of milk produced. The consequence of these effects from epidural analgesia is higher weight loss.<ref name="Takahashi2021">{{cite journal|vauthors=Takahashi Y, Uvnäs-Moberg K, Nissen E, Lidfors L, Ransjö-Arvidson AB, Jonas W|year=2021|title=Epidural Analgesia With or Without Oxytocin, but Not Oxytocin Alone, Administered During Birth Disturbs Infant Pre-feeding and Sucking Behaviors and Maternal Oxytocin Levels in Connection With a Breastfeed Two Days Later|journal=Frontiers in Neuroscience|volume=15|doi=10.3389/fnins.2021.673184|doi-access=free |pmid=34267623|pmc=8276259 }}</ref>