An epidural is a common pain management technique involving an injection near the spinal cord, used for labor, surgery, and chronic pain. While generally considered safe, some individuals experience significant pain during or after the procedure. Understanding the typical sensations and potential causes for increased pain can help manage expectations and identify when medical attention is needed.
Understanding Expected Epidural Sensations
During epidural placement, healthcare providers first numb the injection area with a local anesthetic, which may cause a minor pinch or stinging sensation. After this initial numbing, individuals typically feel pressure, not severe pain, as the needle and catheter are inserted into the epidural space. Some might experience a brief tingling, burning, or momentary shooting pain, but this discomfort usually resolves once the injection is complete. Report any intense or sharp pain to the healthcare provider immediately.
Once medication is administered, numbness develops, often with a feeling of heaviness in the legs, making movement difficult. The epidural aims to provide pain relief (analgesia) rather than a complete absence of feeling. This allows individuals to remain awake and alert, feeling pressure without pain.
Causes of Pain During Epidural Placement
Significant pain during epidural insertion can stem from technical challenges or anatomical variations. One common reason is inadvertent needle placement, such as hitting bone, causing immediate, sharp pain. While contact with a nerve might cause a shooting pain or “pins and needles” sensation, this does not automatically indicate nerve damage, but the needle’s position should be adjusted immediately.
Difficulty locating the epidural space can also contribute to discomfort. Anatomical variations, such as its size or shape, can make needle placement challenging. Patient movement during the procedure can also complicate insertion and lead to pain.
Insufficient local anesthetic before needle insertion can result in more pronounced pain. Rarely, incorrect needle placement at the wrong spinal level or direct nerve trauma can occur. These factors can lead to more intense pain than typical pressure or tingling sensations.
Reasons for Persistent Pain After an Epidural
Pain can also persist after the epidural catheter is placed. One cause is a post-dural puncture headache (PDPH), which occurs if the epidural needle accidentally punctures the dura, the membrane surrounding the spinal cord. This leakage of cerebrospinal fluid leads to a severe headache, often described as a pressure sensation, that typically worsens when sitting or standing and improves when lying down. PDPH usually begins 24 to 48 hours after the procedure and can last a week or longer.
Local bruising or tenderness at the injection site is a common, temporary side effect, often resolving within days. This soreness can be due to insertion pressure, bruising, or muscle aches from holding a position. Rarely, nerve irritation or damage can occur, potentially causing persistent numbness, tingling, or weakness in the lower body. Most nerve damage is temporary, resolving within days or weeks, but can sometimes take months.
Other factors contributing to post-epidural pain include muscle soreness from the procedure itself or a reaction to the medication. Less commonly, infections at the injection site or within the epidural space are also possible, leading to increased pain, swelling, and fever.
When to Seek Medical Guidance
Seek medical guidance if certain symptoms arise or persist after an epidural. Contact a healthcare provider immediately for a severe headache that worsens when sitting or standing, especially if accompanied by nausea, neck pain, or light sensitivity. This could indicate a post-dural puncture headache.
Other concerning symptoms include new or worsening back pain that does not improve, or pain that changes locations. Signs of infection, such as fever (100.5°F or higher), increased pain, warmth, redness, or discharge at the injection site, also warrant immediate medical attention. Any new numbness, weakness, or tingling in the legs or arms that does not resolve, or changes in bowel or bladder control, should be reported without delay. These symptoms could indicate more serious, albeit rare, complications like nerve damage or an epidural abscess.