Increase use of Epidural During Pregnancy (Essay Sample)

Increase use of epidural during pregnancy
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7th April 2013
Increase use of epidural during pregnancy
The word epidural originates from two ancient Greek words ‘on’ and ‘Dura matter’. It is an all inclusive word that is simplified to describe medical techniques such as epidural anesthesia and epidural analgesia. The method of epidural in child birth is often utilized by medical practitioners such as nurses and physicians to employ therapeutic and diagnostic chemical substances alongside other medical agents such as the local anesthesia and analgesia. Frequently, the mode of epidural administration involves drug injections using a catheter that is placed into an epidural space. Subsequently, the injection leads to a sensation loss through the means of blocking signal transmissions in the nerves that are situated in or at a close proximity from the spinal cord. Many times, the relevance of the epidural technique to reduce pain in child birth is confused with the technique of spinal anesthesia. On the contrary, spinal anesthesia is a procedure involving the cerebrospinal fluid in which the anesthesia drug is inserted into the cerebrospinal fluid. Some of the key differences between spinal cord anesthesia and epidural as applied to reduce pain in child birth include; in the application of the epidural technique in child birth, a larger drug dose is technically injected as compared to spinal analgesia. The onset of spinal analgesia in child birth is often faster than the epidural injection. Usually, spinal injections are often conducted beneath the second lumbar vertebral body to prevent accidental spinal cord piercing and ensuing damage. On the other hand, epidural injections are inserted at any point of the vertebral column such as at the thoracic, cervical, sacral or lumbar. Further, using the route of the epidural, it is much easier to conduct analgesia that is segmented such as in child birth as compared to the course of the spinal technique. It is more common to place the catheter that is indwelling in the setting of the analgesia’s that are epidural than with the analgesia’s that are spinal.
In child birth, the injections into the space of the epidural are basically conducted for analgesia. This is conducted through an application of varying techniques. On the other hand, some of the epidural side effects may be advantageous to the subject e.g. one of the side effects, vasodilatation, is very advantageous to patients with peripheral vascular diseases. Often the technique of epidural injection in relieving child birth pain is not likely to lead to the decrease in the power of muscles and neither is it adequate for caesarian surgery. On the other hand, the single technique of epidural anesthesia may be applied to support caesarian sections. In this regard, the p[patient undergoing the caesarian section remains fully conscious in the entire process of the operation. Typically, the medical dose administered in the aesthesia is typically higher than the dose applied for analgesia. Further, the epidural method is also applied in analgesia that is post-operation during child birth. This occurs after a caesarian operation in which the epidural technique was applied being the sole anesthetic or together with the general anesthetic procedure. In a majority of cases, after the caesarian section child birth, analgesia are administered through injections of the epidural space some consequential days after the child birth process as long as there is an insertion of a catheter. Through the utilization of the infusion pump in the Patient Controlled Epidural analgesia, a patient in a capacity to administer to his or her self a frequent dose of the pain relief drug in the catheter of the epidural space is capable of doing the administration.
Further, the technique of epidural is applied in the relief of back pain that is very common during labor prior to the child birth. This happens through the injections of steroids and analgesia into the space of the epidurals with a key goal of minimizing back pain. The application of the epidural technique in child birth involves medical injections into the space of the epidural in which the patient may maintain a lateral position, may be seated or may maintain a prone posture. The spine level for placing the catheter is dependant on the anatomical source of the labor pain, site as well as the intended operation type. The touhy needle is commonly injected along the vertebra bone shelf, lamina, to just prior to the plaum ligamentum alongside the epidural space. The operator of the insertion feels a slight sensation that is clicking together with a sudden resistance loss to the plunger pressure as the tip of the needle enters the space of the epidural and breaches the flavum of the ligamentum. In order to identify the epidural space, many medical practitioners utilize saline or air but saline has proved to be more effective than air because it has more benefits such as analgesia of better quality as well as decreased cases of headaches resulting from post-Dural punctures. After the practitioners insert the needle tip into the space of the epidural, they then proceed to thread a catheter through the needle. Consequently, they withdraw the needle over the catheter. Frequently, there is a 4 to 6 centimeter insertion space of the catheter into the epidural s[ace. The catheter comprises of a plastic tube that is fine, in which the injection of the anesthesia is inserted into the space of the epidural. Many catheters injected into the epidural space often have an end that is blind but have orifices that are more than three along the distal tip of the catheter. This enables in faster and wider disposal of injected agents along the catheter and also decreases incidences of catheter blockage.
During child birth, epidural injections have become more common because they are more effective in providing pain relief than the common analgesia modalities such as opiods, nitrous oxide and TENS. Extensive studies have been conducted on the technique of epidural chlonide in management of child birth pain.
Epidural is a method that has proved to be the safest and most effective in decreasing labor pain as compared to other methods of relieving pain in child birth. In a study by Cochrane review in 2011, that involved 9858 women in 38 randomized studies that were controlled showed that the advantages and disadvantages of epidural in child birth while compared with Opiates were as follows; the main factors that show epidural is the most effective technique in child birth include; the decrease in the number of babies born who required a remedial naloxone for the opiate injected to the mother during labor. The second advantage of epidural as a method of relieving labor was increased pain as compared to other child birth relief techniques. The disadvantages of epidural though relative include increased use of instruments that assist the child birth process, more risk to undergo a caesarian section as a result of distress of the fetus; the fetus does not subsequently move down the bir5th canal, there was increased second stage labor time period, there was a more use of Oxytocin to initiate the contraction of the uterus, the patient were more vulnerable to effects of low blood pressure during child birth, there were more vulnerable to muscular weaknesses during the process of child birth, increased vulnerability to the risk of fever and fluid retention in the period of child birth. On the other hand, epidural did not result to any rate differences to the birth that took place through the caesarian section method and nether were there increased side effects to the babies born out of the technique of epidural immediately after birth. There were no differences in long term back ache to the child births that took place after the administration of the epidural technique.
The varying caesarian section incidences resulted from differences in the institutions value in which the birth took place in, alongside the quality of the medical practitioner providing the child birth service. Epidural analgesia and anesthesia given in the institutions that are rated highly did not result in overall clinical significant differences in the rates of caesarians. On the other hand, the vulnerability to caesarian delivery in facilities that were poorly ranked did tend to rise with the administration of the epidural technique. Consequently, if the epidural technique is administered alongside effective health services, there is a low chance of the process leading to the side effect of a caesarian operation. Another research made the conclusion those women at birth whose epidural injection included fentanyl were not likely to perform full breastfeeding to their babies on the first few days after being born and were likely to subsequently stop the breastfeeding process after the first six months. However, this study outcome received great critic since the study sample was also induced with systemic pethindine which can be a more likely cause of the low breastfeeding rate as a result of higher medication levels in the systems of the pestilent. Further, deeper investigation into the study sample led to the implication that the sample also involved patients who had not been administered with fentanyl and subsequently the findings were not objective.
Traditionally, epidural has been a[plied to relieve labor pain only in the first stage of the labor pain, during the contraction of the uterus until the cervix opens. consequently it has been more effective traditionally in the normal delivery as opposed to the births that took place through the caesarian method. Traditionally the technique has not been applied to relieve pain in the second stage of the labor process, when th...