Before Your Surgery

When should I stop eating and drinking before surgery? Why can't I eat before surgery?

In general, you will be asked stop eating and drinking at midnight the night before your procedure. This requirement is meant to keep you safe from what is called pulmonary aspiration. Aspiration occurs when stomach contents is regurgitated and then breathed into the lungs. Though it rarely occurs, aspiration can be a serious complication of anesthesia and result in significant illness. Current evidence and guidelines suggest waiting at least 6 hours after ingestion of a light meal and at least 2 hours after small amounts of clear liquids before receiving an anesthetic. However, these recommendations are for healthy patients having elective surgery and are therefore subject to change depending on the situation and the opinions of your doctors. You will be given specific instructions by your surgeon and when you are seen in Presurgical Testing. Please follow the instructions given to avoid delay or cancellation of your procedure.

Should I take my medications on the day of surgery?

The answer to this question may be yes or no. You may be asked to take some of your medications but not all of them. If you are taking multiple medications it is likely that you will see your medical or prescribing physician prior to your procedure. At that appointment you should discuss which medications to continue up to and on the day of surgery, which medications to stop and when to stop them. Your surgeon may also have specific instructions for which medications, particularly anticoagulants (blood thinners) that he wants you to stop taking. If you have coronary stents or vascular disease you may need the direction of your Cardiologist regarding your anticoagulants. You may be evaluated in Presurgical Testing and will be called by a nurse prior to your procedure during which you will additionally have the opportunity to discuss your medications. If you continue to be uncertain about taking a medication on the day of your procedure, please bring your medications with you. We may ask that you take them once you arrive.

I have a lot of allergies. Is that a problem for anesthesia?

Many people who require anesthesia have allergies and they are almost never a problem. Please discuss any allergic reaction you have had with the staff and your doctors, including your anesthesiologist. It is helpful to know both what you reacted to and a description of the reaction. Generally, allergies are not a problem because we have anesthetic and medication options that allow us to avoid the substance to which you have reacted. We can almost always tailor an anesthetic to a patients particular needs. Reactions can occur unexpectedly, but their occurrence is rare. Reactions can also vary in significance and severity, from rashes and hives, to breathing problems and anaphylaxis. The most serious, but also rare, reaction to anesthesia is called Malignant Hyperthermia. These reactions can be treated but it is best to avoid them in the first place if possible. If you are unsure or concerned about an allergy, you can also discuss it with your medical doctor or an allergist and be tested to determine if you are truly allergic.

I have sleep apnea syndrome. Is there anything I should do or know before surgery?

If you know you have Obstructive Sleep Apnea (OSA), you should see the physician managing it prior to your procedure. Sleep apnea can be exacerbated by surgery, anesthesia and especially some pain medicines. If you use a CPAP device when you sleep at home, you may be asked to bring that device with you on the day of surgery. Please bring your device if asked, because it may be necessary, for your safety, for you to use it after you receive anesthesia and during your recovery. Additionally, you may require from four to 24 hours of prolonged monitoring after your procedure. That need will be determined by your Anesthesiologist. At times, patients are first diagnosed with Sleep Apnea by their Anesthesiologists during their anesthetic. Those patients too may require fitting for CPAP devices and prolonged observation. Obstructive Sleep Apnea has become a growing area of attention and concern. Our Anesthesiologists are experienced in the care of these patients. If you have OSA, we are committed to getting you safely and comfortably through your procedure.

My child is having surgery. Do you have pediatric anesthesia specialists?

We have seven full time Pediatric Anesthesiologists. Please see “What to Expect – Pediatric Anesthesia” in our Frequently Asked Questions

I have concerns. Can I talk with my anesthesiologist before my surgery?

If you have questions about your anesthetic or would like to talk to one of the Anesthesiologists before your procedure, please contact us via the email portal on this website. In-person consultations can be arranged if necessary. If your procedure will be at Good Samaritan Hospital, you may reach the Department of Anesthesiology during business hours Monday through Friday at 631-376-4000. If you need to call after regular hours, you may call the Good Samaritan Hospital Operating Room and ask to speak with the Anesthesiologist on-call. If unavailable, please leave a number and you will be called back. If you have questions about your operation or procedure, please contact your surgeon.

During Your Surgery

I don't want to be awake or hear anything. Will I be asleep for my surgery?

The primary goals of your Anesthesiologist are to keep you safe and comfortable. Anesthetics have the potential to affect your breathing, your blood pressure and other physiologic parameters. Your anesthetic will be determined by your Anesthesiologist as well as your medical history and the nature of your procedure. Your options and the anesthetic plan will be discussed with you in advance. You can trust that you will be well cared for. In most cases, patients have no memory of their procedures, even if technically they are awake or only lightly sedated. That is because even small amounts of some of our medicines are very effective at blocking memories. If you have specific anxieties or concerns please discuss them with your anesthesiologist and every effort will be made to meet your needs.

I'm afraid I'm going to wake up during my surgery. Is this going to happen?

The chance of you having wakefulness during your procedure is very low regardless of the anesthetic. However, the type of anesthesia you need can vary from local, topical or regional, with or without sedation, to full general anesthesia. Under lighter anesthetics it is at times necessary either for a patient to answer questions during the procedure or for the anesthetic to be lightened for patient safety. In those situations, the patient is still provided with comfort and the wakeful period is usually brief. Also, there are times when it is necessary or patients request to be awake during a procedure. Under general anesthesia, the chance of having awareness is exceedingly rare and unlikely. Regardless of your anesthetic, you will be monitored for changes in several parameters throughout your procedure that indicate your safety, comfort and depth of anesthesia.

Is anesthesia safe? Are there any risks or side effects I should be concerned about?

Advances in patient monitoring and breathing assistance have markedly increased the safety of modern anesthesia. For any procedure you have your heart, blood pressure and breathing will be monitored. For major surgery and for some medical conditions, additional devices including invasive monitors are used to increase the patients safety. The risks associated with anesthesia are primarily determined by the combination of the anesthetic, a person’s medical conditions and the procedure itself. Nevertheless, in most cases a patients risk from receiving anesthesia is much less that what we all face each day when driving a car.

Can an epidural paralyze me?

Paralysis or nerve injury from epidurals or spinals (although possible) is exceedingly rare. Estimates of the risk, though imprecise, place it somewhere between one in tens of thousands to one in hundreds of thousands of cases, possibly comparable to the risk of suffering a fatal automobile accident in a single year (about one in four thousand. The causes of neuraxial anesthesia-related neurologic injury or paralysis include direct nerve trauma, infection, medication reactions and bleeding. It is important to note that this risk assessment represents a broad sample and does not convey the added safety imparted by experienced and highly trained Anesthesiologist performing these blocks. We take these procedures very seriously and perform them in our hospital many times every day. In order to reduce the risk of injury (already very low), special care is taken in choosing patients for these anesthetics and in performing them. Careful attention is paid to the site of the injection, patient comfort and communication during the procedure, sterile technique and avoidance of medicines and medical conditions that increase the risk of an adverse outcome, especially the risk of bleeding. If you are having neuraxial anesthesia and have been taking any “blood thinners” it is important to discuss these medications with your anesthesiologist. We are careful and conscientious in our use of these techniques. It is our opinion that their benefits far outweigh their risks and we believe them to be exceedingly low risk in our hands. We want our patients’ anesthetic experience to be exceptional and only recommend procedures that are to their benefit.

I'm afraid to get someone else's blood. Is the blood supply safe? What are my options for getting blood?

Many precautions are taken en route to you receiving blood products. Blood donors are screened for a history or risk of illness prior to accepting their blood into the donor pool. Once received, donated blood is typed and tested for the presence of infections such as hepatitis, HIV, HTLV and syphillis. In the hospital, blood from a potential recipient is tested in multiple ways for reactivity directly against donated blood. Once safe blood units are identified, a strict set of checks are followed to ensure that the correct blood is given to the correct patient. Finally, considerable effort is made to keep patients safe and stable without the need for transfusion.

Though the process of giving blood transfusions is generally safe, even with our many precautions reactions after transfusion occasionally occur. These transfusion reactions are at times mild immune responses that require little treatment, such as fever, chills or hives. Patients may develop antibodies complicating there receipt of blood in the future. Even more rarely, potentially serious events like disease transmission, the destruction of red blood cells (hemolysis) and complex or exaggerated immune responses do occur, though they are seldom life threatening.

If your surgery is expected and your condition and time allow, you have options other than receiving blood from the blood donor pool. One option is to have some of your own blood drawn and stored for use during your surgery if you should need it. This process is called autologous blood donation and transfusion. Currently, for some surgeries, a machine can be used during the operation that collects autologous blood from the surgical site and processes it during the case for return to the patient. This machine is called “Cell Saver”. Lastly, there is the option of directed donation from a friend or relative.

Overall, your risk of a problem from blood transfusion is very low. We hope this explanation of your options gives you confidence as you approach your procedure.

How long will I be asleep?

Your intraoperative experience of sleep and sedation is discussed in the preceeding questions. After the procedure is over, in most cases you will be awake within a few minutes. However, you may not begin to form memories until you are in the recovery room, usually within thirty minutes of the procedures end. The way you feel at that point and for the few hours and days after surgery is highly variable. Some people can have a major surgery with a significant anesthetic requirement and feel very awake right away. Others can have a small anesthetic exposure and feel quite sleepy afterward. The type of procedure done, the post-operative medications required and the use of pain medicines will impact upon a patient’s wakefulness. Most patients will feel pretty good within 30 minutes to an hour after surgery and largely back to their normal state within twenty-four hours.

What will the anesthesiologist be doing during the procedure?

Your Anesthesiologist is one of your doctors and will be caring for you throughout your procedure. From the time you enter the procedure room until you are resting in the recovery room the Anesthesiologist will be with you. While in the procedure room your vital signs are monitored by the Anesthesiologist. Anesthetics and stabilizing medications are continually administered by the Anesthesiologist to maintain your safety and comfort. Ongoing communication is maintained with the surgeon and adjuestments are made is response to changes and progess in the surgery. Under anesthesia your breathing is established and maintained by the Anesthesiologist. Your post operative pain management regimen is initiated and a record of your intraoperative course is generated during your procedure. The Anesthesiologist safely and comfortably brings you out of your anesthetic allowing you to retake control of your breathing and defensive reflexes without complication or injury. Note: Please see “What is an Anesthesiologist and what does an Anesthesiologist do?”

After Your Surgery

Will I experience a lot of pain after surgery?

While you are under the care of your Anesthesiologist, your pain will be minimal. Prior to the start of the procedure, a plan will be made in discussion with you to minimize and postoperative pain. You will wake from the anesthesia comfortably. At some point after your procedure you may have some discomfort that will be addressed and treated. We employ a variety of methods to control post-operative pain. Spinals, epidurals, a variety of nerve blocks, intraoperative infusions, nonnarcotic adjuvant analgesics and intravenous narcotics are used alone or in combination to provide you with the best possible pain control for your surgery and medical history. Additionally, if you will be staying in the hospital, you may be cared for by our Acute Pain Service. The Anesthesiologists and Nurse Practitioner on this service will see you daily and work closely with you and the surgical staff to give you the best relief possible. Interventions available from the acute pain service include medication adjustments, continuous analgesic infusions and invasive pain procedures such as nerve blocks and the placement of epidurals.

Will I have nausea and vomiting after surgery?

If you have had significant nausea and vomiting after surgery it is important to discuss it with your Anesthesiologist.

Our Anesthesiologists and the staff in all our practice locations are committed to giving you the best possible operative experience. Current medications for the prevention and treatment of post operative nausea and vomiting are highly effective. Most people come through surgery comfortably and without nausea. There are a variety of medications and anesthetic techniques used to prevent and treat nausea if it does occur.

Depending on your procedure and history you will receive an appropriate preventive anti-nausea treatment. These measures are effective over 90% of the time. Occasionally, there are patients who develop nausea even after preventive measures and medicines. And only rarely do patients develop nausea that is persistent and resistant to treatment. Some surgical procedures are more likely to cause nausea than others, such as gastric and abdominal surgeries. Also, combinations of anti-nausea medications can at times cause sedation and confusion. Therefore second and third line treatments for nausea are usually given in a stepwise fashion as needed. Together our nausea treatments are highly effective and you can approach your surgery with confidence that you will do well and, most likely, feel quite good.

What happens when the procedure is over?

In most cases, when your procedure is over you will quickly be awakened from the anesthesia and taken to the Post Anesthesia Care Unit (PACU), also called the Recovery Room, for observation, monitoring and treatment of discomfort or other medical consequences of the surgery. You may not start forming memories until several minutes after awakening and therefore won’t remember leaving the operating room. It is required that you be observed for a minimum of 30 minutes after arrival in the Recovery Room, though the time of observation can be considerably longer if necessitated by your condition or medical issues such as Sleep Apnea. Day Surgery patients may go directly home from recovery or be transferred from the PACU to an Ambulatory Surgery Unit where you will be assisted and evaluated by nurses to eat, drink and prepare to return home. It will take at least one hour after first arriving in recovery before you will be ready to return home.

Will I be able to see my family after surgery?

Every effort will be made to reconnect you with your family as quickly as possible. In most cases, the surgeon will call a member of your family as soon as your procedure is complete. You will usually see your family within an hour of the surgery ending and often within 15 minutes. There are times when patients need extra care or extra time in Recovery that prevents family from being able to see them or requires that family leave the patient after a brief visit to allow the doctors and nurses to do their work.

For children having surgery, the goal is to have parents at the bedside as soon as their child comes out of the operating room. (Please See Pediatric FAQ’s for more information.)

I have sleep apnea. Can I go home after surgery? What else should I know?

We regularly care for patients with Obstructive Sleep Apnea (OSA) and can safely provide anesthesia for these patients. Sleep Apnea will not generally prevent you from having a surgical procedure or anesthesia. However, for some patients special precautions will be required to ensure safe breathing during their procedure and recovery. If you use a CPAP device for home management of your OSA, you will be asked to bring it on the day of surgery. You may be asked to wear your device during your recovery, though that is not usually necessary. Additionally, depending on the severity of the Sleep Apnea, the nature of the surgical procedure and the amount of pain medicines required, prolonged post-operative monitoring of patients is sometimes necessary. Because surgery, anesthesia and pain medicines can all worsen Sleep Apnea, monitoring is primarily to ensure safe and adequate breathing. In order to go home after surgery, all patients need to demonstrate that they can maintain adequate oxygenation for their bodies without the extra oxygen that can be provided in the hospital. OSA patients are prone to deoxygenation and are therefore often observed for a minimum of 4 hours after surgery and sometimes overnight. Sometimes we make a diagnosis of Sleep Apnea on the day of a patient’s procedure. If you know that you have Sleep Apnea please discuss it with your surgeon, anesthesiologist and the hospital staff.

What effects might I normally expect in the days after anesthesia?

Most patients feel little if any residual effects from anesthesia after 24 hours. The anesthetics themselves will be gone from the body in detectable levels by that time. Healing from your surgery and taking pain medications may make you feel tired and slow during this period. There are occasional people, especially in older populations, who are sensitive to anesthetics and report not feeling quite right for up to a few days after receiving anesthesia. Rarely, a patient will report a prolonged decrease in their feeling of mental sharpness. Thankfully, this is very infrequent and the medical community continues to search for an explanation of this phenomenon.

Who should I contact if I have a problem or concern after my procedure?

If you have questions about your surgery, please contact your surgeon. If you have a concern or problem you believe is related to anesthesia, please contact our department directly. If you had a procedure at Good Samaritan Hospital, you may call the hospital operating room at 631-376-4088 during business hours and ask to speak with an Anesthesiologist. After hours, please ask to speak to the Anesthesiologist on call. If no one is available, leave a message and you will be called back. If you had a procedure at another of our practice locations, please email us through this site and we will get back to you. If the matter is urgent, please contact your surgeon and their office will reach us so that we can call you back.

Am I going to get addicted to pain medications after surgery?

Addiction or psychological dependence is extremely rare for people taking opiates for short-term pain control after an operation. The available data confirms the idea that fear of opiate addiction should not be a primary concern in treating postoperative pain. In fact, there is excellent evidence that good postoperative pain control is crucial to facilitate early mobility and a complete rehabilitative process. Tolerance (where the body becomes resistant to higher and higher doses of opiate medication) and physical dependence (where the body goes through a withdrawal syndrome after discontinuation of the medication) can develop with long-term use of opiates, but is exceedingly rare in the postoperative setting. Tolerance and physical dependence are often confused with but not the same as addiction or psychological dependence.

The incidence of addiction to pain medicines after surgery is exceedingly rare. The occurrence is so rare that current medical recommendations state that addiction need not be a significant concern in treating acute post operative pain. Good pain control is actually a necessary and important part of the healing process. It is important to note that addiction or psychological dependence is separate from what is called tolerance or physical dependence. The body can develop tolerance and dependence after prolonged use of opioids and may require higher doses of narcotics to achieve the same effect. Also, with physical dependence there may be withdrawal symptoms when narcotics are discontinued. Fortunately, in the hospital and post operative setting these conditions are very rare. They are different from addiction, that is even less likely. You can have confidence that achieving good post operative pain control is a safe part of your overall recovery.

Am I at risk for blood clots after surgery? How can I decrease my risk?

The incidence of blood clots after surgery varies greatly. When blood clots do occur, they can be life and limb threatening and are therefore, taken very seriously. Some surgeries are known to have a higher risk of blood clot formation, referred to as DVT (deep venous thrombosis). For all surgeries, general preventive measures are taken including the use of lower extremity intermittent compression devices. For those surgeries with higher rate of thrombosis, extra precautions are used including anticoagulant medicines and specialized anesthetics. In particular, spinal and epidural anesthesia has been shown to decrease the incidence of blood clots after total joint replacement. Our anesthesiologists will guide you to the best anesthetic for your procedure.

Your risk for blood clots can be further diminished by understanding risk factors and following the advice of your physicians before and after surgery. Smoking is a significant risk factor for multiple post operative problems including DVT. Obesity, estrogen (sometimes related to oral contraceptives), prior DVTs, some medical conditions and post operative immobility are all risk factors for blood clots. It is recommended that you discuss risk modification with your doctor before surgery.

After surgery, you can promote blood flow and reduce your risk of blood clots by doing prescribed exercises and walking with assistance, as recommended by your doctor, as soon as possible.

Will I get a bill for my anesthesia?

Your Anesthesiologist plays an important role in your surgery, administering anesthesia to ensure your comfort, doing procedures and delivering medicines to maintain your safety, enabling your surgeon to perform the procedure, waking you safely at the end of the procedure, and caring for you during your recovery. The Anesthesia Department may also be asked to manage your post operative pain via our Acute Pain Service.

After your procedure, there will be bills from your surgeon, the hospital and the anesthesiologist. Just like the surgeon and hospital, the anesthesiologist has a fee. Revenues in Anesthesiology come almost entirely from these case-related charges. The fees are generated by consideration of the severity of your medical condition, the risk of the surgery, the type of anesthesia, related peri-operative procedures, and the duration of the anesthetic care.

Our department participates in most insurance plans and we continue to work toward in-network participation with all insurance carriers. We participate with Medicare and Medicaid. Participation in private insurance plans requires periodic contract negotiations that at times results in movement to out-of-network status. In recent years, it has been unfortunately common for insurance companies to break their contractual obligations to physicians and withhold payments without justification. Responding to this practice has required extra cost and administrative effort by doctors offices and we continue work toward fair and lawful conduct by insurance carriers.

Additionally, insurance coverage for patients continues to change. We understand and are aware of the burden this may place on some patients. Now, most patients will have a deductible and copay for their medical services. Therefore, the amount of the bill for which you are responsible as a patient is variable. In some cases you may be required to intervene with your insurance company to ensure that they cover all the charges they should. Our billers may be able to assist you in this process. If you have an outstanding balance after your insurance payment you may be responsible for that amount. In the case of financial hardship or other extenuating circumstances, you must contact our billing service to address the issue. Regardless of the situation, if you have questions about your bill, please contact our billing service for assistance. Please see our Insurance and Billing page.

Labor & Delivery FAQ

What are spinals and epidurals

During labor and delivery, it is our goal to give patients the best possible pain relief, in the safest and most effective manner possible. Currently we can give the most relief with the smallest amount of medicine using spinals and epidurals. These techniques are essentially injections given in the lower back. They are very safe, very well tolerated and we place thousands of them every year. A spinal involves a single injection of medicine into the spinal fluid using a very small needle. Spinals are at times used for labor, sometimes in combination with epidurals, and most often for cesarean section. Lumbar epidurals are the most common form of pain relief during labor. A special needle is used for epidural injection. Through this needle, a very small medication line is placed into the lower back. That line is then used to give continuous medication and pain relief for the duration of labor and delivery. For both spinals and epidurals the strength of the effect is determined by the strength of medication administered and can very from mild pain relief to total anesthesia and temporary elimination of all sensation from the nerves serving the uterus, abdomen and below. Therefore, a significant benefit of epidurals is that they can be used for safe and rapid anesthesia if there is a need for emergent cesarean delivery.

When should I have my epidural placed? Will an epidural slow down my labor?

Epidurals can be placed with great effect at nearly any point during labor. Ultimately, the decision about when to place your epidural will be between you and your Obstetrician. It is our philosophy that epidurals should be placed as early as possible, based on available evidence about the effects of epidural medications on the progress of labor. Current studies show that standard epidural medications have no effect on the duration of the first stage of labor (from the onset contractions to complete cervical dilatation.) Some studies have shown that the second stage of labor (from complete cervical dilatation to delivery) may be prolonged by a few minutes. However, recent evidence suggests that early administration of epidurals may shorten labor overall. It is easiest to place the epidural catheter (medication line) before contractions become significantly painful, when it is easy for a laboring woman to sit still and cooperate with the procedure. With this in mind, it is even possible to place the epidural catheter without starting the epidural medications. That way the procedure is done, the catheter is in, and when contractions become painful, the medications can simply be administered.

Will the epidural affect my baby?

Epidurals have been shown to be safe for your babies. Epidurals provide significant pain relief with very small amounts of medication. In fact, the relief provided by epidurals has the benefit of decreasing fetal exposure to maternal stress hormones. This is in contrast to the option of taking systemic pain medicines during labor which requires much higher doses, and affects both the mothers whole body as well as the baby’s.

Can I become paralyzed from an epidural?

Paralysis or nerve injury from labor epidurals or spinals, placed in the lower back, is exceedingly rare. It is even more rare than for spinals and epidurals overall that may be placed along the entire length of the back and neck. In the lumber (lower back) region, the spinal cord is no longer a solid structure but has divided into a collection of small spinal nerves that are floating in the spinal fluid. The mobile nature of these nerves allows them to move out of the way in the rare instance that a needle may contact them, further reducing the risk any direct nerve trauma. Additionally, our Anesthesiologists place thousands of labor epidurals every year. We take these procedures very seriously, perform them with great care and want every patient, especially our laboring mothers, to have a positive labor experience free from complications. Careful attention is paid to anything that could increase the risk of an adverse outcome, especially the risk of bleeding along the spinal canal. If you have been taking any “blood thinners” or special injections during your pregnancy it is important to discuss these medications with your anesthesiologist and the hospital staff.

Please also see: “What to Expect During Surgery”

Can I walk with my epidural?

Though it is possible to walk with certain epidural medications, during labor we do not allow patients to walk after the epidural medications are administered. This practice is true at most institutions. Extra precautions are taken in the setting of labor. If you should require a cesarean section or have other abdominal surgery, an epidural can be set up that allows ambulation. However, this method would be determined by the anesthesiologist on a case by case basis.

Can I eat and drink after my epidural is in place?

We ask that you do not eat or drink, other than ice chips, after placement of the epidural and administration of the epidural medications. Just like before surgery, this restriction is for your safety. An empty stomach decreases your risk of pulmonary aspiration (stomach contents getting into your lungs), nausea and vomiting. Food or certain liquids in the stomach put you at risk for aspiration if you need general anesthesia for emergency purposes or if you need emergency surgery, even cesarean. We take many precautions to ensure your safety around the time of your delivery.

What happens if I need a C-section?

If you need a Cesarean Section (C-section) for delivery of your baby, unless it is an emergency, you will most often require spinal or epidural anesthesia. The most important thing is to remain calm. The doctors and staff will guide you. Our number one goal in the end is to have healthy moms and healthy babies. C-section is abdominal surgery, though it is limited in its extent. You will need anesthesia for the procedure. Spinals and epidurals have been shown to be safer for pregnant woman than general anesthetics. Additionally, these neuraxial anesthetics (see “Anesthesia Techniques”) have the added benefit of allowing you to be awake for the delivery of your baby even for surgical delivery. If we can avoid giving you general anesthesia for C-section, we will. If you already have an epidural in place, we can give you a stronger medicine through the epidural catheter. This method is safe and fast, making it ideal for emergency situations. The stronger medicine will make your abdomen numb for the surgery. If spinal is needed, all that is involved is a small injection in your lower back. The injection is generally quick and well tolerated, and will likewise make your abdomen numb so you won’t have pain during the procedure. We often also administer spinal or epidural medicines that work to keep you comfortable in the hours and days after your surgery. After surgery, we will tailor a regimen of medications to alleviate your pain and the Acute Pain Service will see you and adjust you pain medicines as needed to allow you a rapid recovery.

What are my pain relief options during labor?

The options for pain relief during labor include focused breathing and relaxation, intravenous (systemic) narcotics, spinals and epidurals. All of these methods are safe when managed appropriately by physicians. While women have had successful labor using all of these methods, it is evident from available studies and our own experience that epidural analgesia is by far the most effective and beneficial. Intravenous medications travel throughout the entire body including the brain and the baby. The medications given I.V. are narcotics, most commonly Stadol (butorphanol) or Demerol. These medications generally require higher doses to achieve good effect and because they are systemic can result in sedation and confusion. Both intravenous and spinal medicines are likely to require redosing during labor, each lasting only 1-4 hours with each dose. Spinals and epidurals use a combination of local anesthetics (like lidocaine) and other opioids. Local anesthetics directly reduce or eliminate pain signals from nerves. Therefore, these combinations given excellent relief using very small amounts of medicine. Spinals are given with a single injection. Epidural medicine is given continuously using a very small catheter (medication line) that is placed in the back. Mothers laboring with epidurals experience less stress and use less systemic medication. Studies have shown better fetal outcomes in these patients. Additionally, as mentioned above, an epidural catheter can be used rapidly and safely to give surgical anesthesia in the event of an emergency requiring rapid cesarean delivery. There are women who do well and have successful deliveries without pain medications or epidurals. Given the significant safety, effectiveness and potential benefits of epidurals for labor, we strongly support their consideration for use during your labor.

Are there any potential side effects or risks from spinals or epidurals?

Spinals and epidurals for labor and delivery are exceptionally safe. As discussed above, the risk of nerve injury and paralysis from these lumbar (lower back) injections is exceedingly rare and unlikely. Epidurals and spinals for labor are also unlikely to affect preexisting lower back problems. In fact, epidural injections are often used to treat disc and nerve related back and leg pain. Spinals and epidurals can cause a mild bruise at the injection site. Spinal and epidural narcotics, often used in small dose combinations with local anesthetics, can sometimes cause mild itching and the local anesthetics themselves can cause a varying degree of temporary numbness in the legs and abdomen. It is this numbness that provides some of the pain relief. However, we seek to find the right balance for each patient between good pain relief and enough strength and sensation to push well at the end of labor when it is time to deliver.

Another potential side effect from spinals and epidurals is headache. There are several potential causes of headache after delivery, most of which are not related to neuraxial injections. The kind of headache related to these techniques is called a Post Dural Puncture Headache (PDPH), commonly referred to as spinal headache. These headaches are infrequent, develop in the first few days after delivery, and can occur as a normal side effect of neuraxial injections. Occasionally, epidural placement will indicate the need to watch for headache. Spinal headaches also occur unexpectedly. They can resolve spontaneously but often require another lumbar injection to treat. Treatments for spinal headache are very effective. Our anesthesiologists are skilled and experienced in the care of laboring patients and the placement of neuraxial anesthetics including labor epidurals. While the true incidence of PDPH nationwide is difficult to estimate, the rate of occurrence in our institution has been far less that available averages.