Epidural needle: should we really be afraid of it?
Photo by Hush Naidoo Jade Photography on Unsplash

Any pregnant woman who has been brought to see an epidural needle before D-Day keeps a chilling memory. Why is it so long? Is the setup painful? Are there any risks or complications? The point of the epidural is to reassure worried mothers-to-be.

What is the diameter and size of an epidural needle?

The epidural needle, with its diameter of 1.3 mm and its length of 8 cm on average, is enough to frighten the most adventurous. For comparison, a needle for a blood test is 3 cm long and 0.8 mm in diameter.

The epidural needle is also known as the Tuohy needle, namely that of its inventor Dr. Edward B. Tuohy, president of the American Society of Anesthesiologists in 1947.

The diameter of the needle is important because it allows the passage of the catheter which is slipped into its cavity and its length is intended to reach the dorsal vertebrae. The size of Tuohy needles can vary and go up to 15 cm in length for women in obesity, whose layer of fat lengthens the path to the vertebrae.

Epidural: what are its specificities?

The epidural needle, in addition to its large size and large diameter, has several specificities, which make it safe and effective for performing anesthesia.

  • Its curved tip makes it possible to administer an anesthetic while preventing accidental penetration of the hard layer of the spinal cord;
  • On both sides of the needle stem are protrusions that allow additional force to be exerted when it is inserted into the subarachnoid space of the spinal cord;
  • The needle also has a transparent base, thanks to which a possible backflow of blood or cerebrospinal fluid can be visible;
  • Finally, thanks to alternating colored bands visible on the stem of the needle, the anesthetist controls the precise measurement of the length of the needle already inside the body.

Course of epidural placement

To place the epidural on a patient, two positions are possible:

  • lying on its side;
  • seated, back rounded.

After performing the small local anesthesia, the doctor inserts the epidural needle into the epidural space passing between the third and fourth lumbar vertebra. He then introduces the catheter, which will deliver the anesthetic product. The needle is then removed, leaving the catheter in place for the duration of delivery.

Epidural injection: why should we not be afraid of it?

If the epidural needle can legitimately frighten, it should not be forgotten that its primary purpose is to significantly reduce the pain related to labor contractions and the passage of the baby through the cervix.

And it is no coincidence that 82% of future mothers finally decide to use it and that the vast majority of them are satisfied. Moreover, among 1/4 of them who do not wish to use it before delivery, about half finally ask to receive it during labor.

A proven technique

Developed in the 20s by the Spanish doctor Fidel Pagés Miravé, the epidural was democratized and imposed in Europe in the 70s to be fully supported by Social Security in 1994 under the impetus of Simone Veil. More than 600,000 women benefit from epidurals each year in France, the vast majority of whom are generally satisfied.

Very rare complications

Knowing that a needle is going to approach our spine is always worrying. Rest assured, the main risks inherent in the epidural are the occurrence of headaches, generalized itching, or a small drop in blood pressure.

All are transient and disappear quickly. Very exceptionally, it can happen that a nerve is damaged by the wrong position of the needle. The consequence is then numbness of an area of the lower limbs.

Little pain

As impressive as the epidural needle may be, the prick and placement of the catheter are very painless, as a small local anesthesia of the skin has been previously performed.

It does not prevent you from feeling the baby pass
Finally, among the reluctance regularly mentioned by future mothers, is the fear of not feeling the baby pass and not feeling the contractions.

If it can happen that the anesthesia is highly dosed and deprives the mother of most sensations, this is less and less the case. Today, most maternity wards offer a self-controlled epidural, which allows the mother to dose her anesthetic according to her pain.

In case of complications of childbirth: it allows the realization of a caesarean section
Finally, in 10 to 15% of women, an emergency caesarean section may be necessary during labor, in case of difficulties or complications. If the epidural is already in place, it allows the caesarean section to be performed without additional anesthesia.

Image Credit: Photo by Hush Naidoo Jade Photography on Unsplash

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