Intrathecal Anesthesia

What is the difference between an epidural and an intrathecal? Military hospitals in Europe offer only intrathecals, but there is very little information available on what the real difference is. The doctors here claim they are the same, and not to be concerned that the epidural is not an option.


Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

There are several anatomical layers that cover the spinal cord. The "space" just above the cord and the cerebral spinal fluid is called the subarachnoid or subdural space. The area adjacent or above this is the epidural space. Whenever the "dura" (lining of the spinal cord) is punctured, the instillation of anesthetic carries the risk of getting "too high" and interfering with maternal respiration. But epidural anesthesia is placed in contact with but not entering the dura.

Instillation of intrathecal medication is a newer technique but it is performed in much the same way. A very small dose of an opiate (usually morphine) or an opiate mixed with a local anesthetic can be placed in the same place using the same technique as is done with the epidural. The risks of toxic effects of local anesthetics and the risk of getting "too high" are minimal because of the small dose necessary.

The same prerequisites apply to intrathecal as they do to epidural analgesia. The client should be in active labor with no fetal compromise and she must not be allergic to the agents used. The main side effects from intrathecal medications is itching and nausea. Some reports show better fetal tolerance, and the mother is more relaxed and able to work with her contractions. When we use this type of analgesia, mothers tend to progress in labor and can feel the urge to push and work with the contractions during second stage when they need to push.

I prefer intrathecal to epidural for those women who need such intervention and if you need some of these more interventive techniques during labor, intrathecal is a good choice. The necessity of fetal monitoring, IVs and some less mobility will be necessary, however, just as with an epidural.

I wish you luck and try not to worry about this type of anesthesia if you need it.

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