Once the spinal needle is placed through the epidural needle, a quick acting
narcotic is given through it. Sometimes a very small dose of a local
anesthetic is also given. When these medications are injected, the patient
should begin to feel pain relief begin within a minute or two. The spinal
needle is then removed. Note that the epidural needle remains in the correct
location and is not removed at this point.
After the spinal needle is removed, a catheter is placed through the
remaining epidural needle, the needle removed and the catheter secured to
the patient’s back with tape. It is now possible to administer additional
medication as needed through this catheter. The procedure is then complete.
Your blood pressure will be monitored for any severe decreases and to treat
drops in blood pressure promptly. This is not difficult to do and requires
only a period of careful monitoring after the completion of catheter
placement and injection of medication. Also it is important to stress that
the you should not be allowed to walk without first testing muscular
strength – everyone reacts differently to medication and not everyone can
walk, even after receiving a walking” epidural.
Many women prefer this type of epidural, because it leaves them in
control. Walking epidurals allow the mother to get up, walk around or even
use the restroom. Women with walking epidurals are able to regulate their
own dosage, giving themselves more of the pain-relieving medication as they
feel the need. Walking epidurals carry minimal risk to both mother and child
and cost the same as a standard epidural.
There are some disadvantages to the combined spinal-epidural technique when
compared to a traditional epidural.
- It is slightly more technically involved than an epidural without a
- The placement of a hole in the dura can be the cause of a headache
after the spinal.
While rare – this headache can be a major annoyance for the patient after
labor and delivery is completed. The good news is that since the spinal
needle does not need to penetrate any of the body (except the very thin dura
membrane), it can be a very small needle which causes a very small hole.
This decreases the chance of getting a headache to less than one percent.”