Epidurals for labor pain

Some variations of the basic epidural are:

  • Narcotic-epidural -- It has become common to replace some of the anesthetic with a narcotic in an effort to obtain equally good pain relief while reducing some of the adverse effects of the anesthetic. A variation is to start with pure narcotic and move to a mixture when you desire stronger pain relief. The administration procedure is the same.
  • Walking epidural -- With the so-called “walking epidural,” the anesthesiologist either injects narcotic only or injects an ultra-low dose of anesthetic or anesthetic mixed with narcotic. With pure narcotic, you can, indeed, walk. With anesthetic, walking requires care and assistance. Despite feeling normal, the epidural still affects muscle strength, your ability to sense your balance and your reaction time to correct imbalance. Also, many women find pain relief to be inadequate (3).
  • Combined spinal-epidural -- With a combined spinal-epidural, the anesthesiologist injects an initial dose of narcotic or anesthetic beneath the outermost membrane covering the spinal cord and inward of the epidural space (intrathecally). He or she then pulls back into the epidural space, threads a catheter through the needle and withdraws the needle, leaving the catheter in the epidural space. Intrathecal injection isn’t repeated, so this technique allows you to have a regular epidural should you want additional pain medication later. If, as is more common, the spinal injection is narcotic, you will get some, but not complete pain relief, but unlike the epidural, you will still have complete mobility.
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