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Thread: Pain Relief
December 13th, 2012 09:33 PM #31
Yeah they gave me the pictocin well before they gave me the epidural, so by the time I had it, I was in a lot of pain. They did the catheter [the first time] right after they gave me the epidural.
I thought when they do the catheter thing, they are supposed to leave it in. They didn't when I was at the hospital. I don't know if that's normal or I just had a nurse that wanted me to suffer lol.
December 13th, 2012 10:21 PM #33Senior Member
- Join Date
- May 2012
Blade- a question for you if you are checking back at all. When I had my epidural withing minutes my legs down to my toes were completely numb I could not even move my toes. Not even when they turned down the dose of medicine very low. What would be the causes of this? Was it not placed correctly? Also, I have mild scoliosis and I think they said something about that making a difference, but I can't quite remember. Would that have an effect on how it works? One side was also more numb than the other. I actually hated having the epidural for that reason. I was told I'd be able to move my legs and toes probably when they turned it down so I could still get up and move around a bit and change positions, but I could not. Which is part of the reason why I ended up with a c section I believe. I was lying in bed a VERY long time. Also, next time I will be asking for the IV in a different place. It hurt so bad in my hand and I was always forgetting it was there and accidentally bending my wrist back to far and my whole hand got swollen and puss was oozing out of the needle area. It was awful!
December 13th, 2012 11:38 PM #35
If you do wind up in the bed, either because it's not as tiring or because your doctor wants you there, you can try a side-lying position instead of staying on your back.
December 14th, 2012 02:23 AM #37Senior Member
- Join Date
- Apr 2011
Blade, I know you bring a knowledgeable medical perspective, however my personal experience is in stark contrast to what you are describing. I gave birth using nitrous oxide (self-administered during contractions) and successfully pushed both my babies. There was never any trouble coordinating pushing. I also changed positions numerous times during my 9 hour labor without any difficulty (well no more than I had had prior to labor- moving around with a huge twin belly is not exactly the simplest thing). I am not saying I don't believe that nitrous oxide can have the effects you describe, but I wonder if the concentration used here in Europe is different as I am sure they would not be using it if their version produces such drastic effects as you say. I also imagine the effects can vary from person to person.Mama to my boys, the 'twinadoes', and a little Tingeling.
December 14th, 2012 03:13 PM #39
The space where an epidural is placed is called a "potential space." That means unlike, say, your mouth, which is a cavity no matter if it's open or closed, normally without a catheter or medication in there, there is no space. Instead the ligaments are adherent to the dura. Think of a piece of saran wrap (or clingfilm if you're in the UK) attached to a glass. No space between-- but if you just peel off one tiny edge, the whole thing separates beautifully.
The dura surrounding the spinal cord is not a smooth cylindrical tube. The "space" has a very complex 3D geometry bounded by the vertebrae, ligaments & connective tissue on one side, and the dura-covered spinal cord on the other. As such it's different in every human being, and difficult to predict exactly what shape it takes.
In scoliosis your geometry is even more different. The ligaments & connective tissue are straight, up and down, but the bony spine itself is curved to the side. Try to imagine this space I'm talking about. And then imagine how a bent spine could sort of pinch off the flow of medication from one side (where it's infusing) over to the other.
The biggest complaint with epidurals is that, for many women, you have a "hot spot" or one area served by one spinal nerve root that isn't adequately anesthetized, and you experience near-full sensation in that one spot only. It's difficult to predict because again everyone's 3-D epidural space has different geometry. The anesthesiologist has to make a best guess as to where to place the catheter so that the average woman will experience a block at all nerve roots, but it can't work 100% of the time.
The catheter *can* work its way out of the space. When I said above that you can't hurt yourself with it and it can't go where it shouldn't, that's absolutely true. It's a soft floppy thing that you can't direct or guide or make go anywhere. But it can go backwards-- if you pull on it at the skin, for example-- and it can work its way out, such that the tip of the catheter is now just in your spinal ligaments or even the soft tissue/fat of your back. Obviously that doesn't work for pain relief and in that situation, the epidural has to be replaced.
Libby-- different local anesthetics have markedly different half-lives. The longer the half-life, the longer it stays around to have an effect. If bupivicaine was used (which is common), the half-life is nearly 3.5 hours. Therefore you don't feel the effect of a dose reduction until that initial large dose wears off. Lidocaine, on the other hand, has a half-life of only 90 min, so you can adjust the dose and see a response more quickly.Blade, MD
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