Epidural varicose veins

Development of hormonal varicose veins

Important! Doctors are shocked: “An effective and affordable remedy for varicose veins of the lower extremities exists. " Read more.

Today, there are many types of diseases of the circulatory system, one of such ailments is hormonal varicose veins. Varicose veins, or varicose veins, are a serious disease of the blood vessels. Many factors can influence the development of the disease, including regular psychological discomfort. But there is no effective treatment that can permanently eliminate the disease. Therefore, in order to avoid the development of the disease, it is important to know its causes and types.

Etiology of varicose veins

OUR READERS RECOMMEND: A SIMPLE WAX CREAM WILL REMOVE A REMEDY FOR VARICOSE AND EDEMA. READ MORE >>>

Varicose veins belong to a polyetiological group of diseases, that is, the cause of its development can be various factors: from hormonal imbalances to genetics.

A common cause is valvular insufficiency. Due to the dilation of the veins, the valves cannot

function correctly: they do not block the lumen of stretched veins as a result of deformation and degeneration. In addition to the acquired form, there is also a congenital form of varicose veins, in which such a disorder occurs through no fault of the person.

Proponents of the hereditary theory believe that varicose veins are a pathology of blood vessels caused by genetic factors. The theory is supported by the prevalence of the disease in people whose relatives had the same disease. Two factors influencing the development of varicose veins can be genetically determined: weak walls of blood vessels or pathologies in the development of venous valves.

The mechanical theory suggests the development of varicose veins with deterioration of blood circulation in the lower extremities along with high internal pressure. Therefore, such varicose veins often develop in people who are forced to spend a lot of time on their feet: hairdressers, surgeons, sellers, loaders.

Another common theory is the development of varicose veins under the influence of hormones. It is known that when the level of female hormones increases, for example, during pregnancy, the walls of the veins lose their tone, and symptoms of the disease may appear, disappearing after the birth of the child. Often the appearance of varicose veins is accompanied by puberty, and quite often menopause.

According to one theory, varicose veins can even cause an unstable psychological state: depression caused by lack of self-confidence and a prosperous future, the inability to stand firmly on one’s feet.

Despite the abundance of theories, none of them can accurately explain the etiology of the disease. For example, varicose veins may not affect both legs, but only one limb. Not in all cases the development of varicose veins can be explained by hormonal imbalance. Sometimes the genetic theory is untenable: children of patients with varicose veins are not always susceptible to this disease.

Impaired blood circulation provokes malfunctions in the functioning of the pelvic organs.

Classification of varicose veins

There are a huge number of classifications of varicose veins. First of all, it is worth listing the types of varicose veins by location.

Many people believe that varicose veins develop in the area of ​​one or both lower extremities, which is not always true.

Varicose veins of the lower extremities vary according to the nature of the disease:

Ascending nature of the disease. In this case, the disease begins to develop from the foot. Usually caused by a malfunction of the valves in the veins of the leg, thigh or foot.

Descending. The process develops from the mouth of the saphenous vein.

Varicose veins of the upper extremities are relatively rare in the form of a congenital anomaly or as secondary varicose veins after the formation of a blood clot in the subclavian vein.

There are known cases of diagnosing severe varicose veins of the male and female genital organs, the perineum and buttocks.

Internal varicose veins are noticeable only during the examination. Varicose veins of this type cause damage to internal organs.

Epidural varicose veins are lesions of the veins (one or more) passing in the area of ​​the intervertebral foramen. Depending on the degree of damage, epidural varicose veins can be segmental (local) or widespread.

Depending on the shape of the ectatic areas, the following are distinguished:

International classification CEAP

In 1994, another classification of varicose veins was developed - CEAP. It received its name from the first letters of the corresponding sections in English: clinical, etiological, anatomical and pathophysiological.

Over the several years of its existence, CEAP has become widely known and is currently used by many specialists around the world. Initially, CEAP had certain shortcomings, which were eliminated in subsequent editions of the classification of varicose veins. Today it looks like this.

The clinical section evaluates the patient's disease status. The reason for determining the class of the disease is the presence and severity of signs of varicose veins. Stages are indicated by English C with a digital stage designation from 0 to 6, with 0 indicating the absence of palpation signs of varicose veins, 6 indicating the presence of an open venous ulcer. If there are individual symptoms, for example, itching, night cramps, burning, etc., the letter S (CS0) is added to the clinical class designation. If there are no such signs, A is put instead of S.

In the etiology section of the CEAP, the etiology of the disease (E) is indicated as follows:

Ec - congenital form of the disease;

Ep - primary varicose veins;

Es - secondary varicose veins;

En - the study revealed no signs of the disease.

In the anatomical section (A) they indicate which part is affected by varicose veins: s - superficial vessels, p - perforating vessels, d - deep vessels. N is indicated in cases where no signs of damage are found.

In the pathophysical section, hemodynamic disorders of the veins are indicated (P). The presence of a reflex is indicated by r, occlusion - o, r, o - a combination of these disorders. Accordingly, n indicates when no blood circulation disorders are detected.

Stages of varicose veins

Varicose veins vary depending on the stage of the process. Features of the course of the disease make it possible to divide the entire process into 7 stages: 1 initial and 6 main ones.

The zero stage of development of varicose veins is characterized by an almost complete absence of external signs. The development of varicose veins at the initial stage is characterized by slight fatigue in the legs.

At the first stage, varicose veins are already pronounced, small varicose nodes are noticeable. Other characteristic symptoms appear more clearly; muscle cramps are observed in the evening and at night.

At the second stage of the development of the disease, in addition to small varicose veins, stretched veins are also noticeable. This stage is also called middle varicose veins. The veins are weakly visible, their diameter is up to 4 mm.

Next (stage 3) swelling appears. The legs may swell greatly, and excess fluid is not removed even after rest.

Stage 4 is characterized by swelling in the ankle area. The color of the tissue changes, becomes darker, and scars appear.

At stage 5, the peripheral veins are in a neglected state. The formation of trophic ulcers and scarring of skin defects are observed.

Finally, at stage 6, highly noticeable chronic trophic ulcers appear in the lower leg area.

Regardless of the form of varicose veins, if not treated correctly, the disease can become chronic. In this case, the likelihood of a complete cure is noticeably reduced. Chronic varicose veins do not appear suddenly; they develop gradually with long-term lack of attention to the symptoms or improper treatment.

Methods for diagnosing varicose veins

Depending on the type of disease and some characteristics of the body, diagnosing varicose veins can be difficult in some cases. But only after diagnostic studies can an accurate diagnosis be made and treatment prescribed.

At an early stage, diagnostic studies are difficult (and therefore often not carried out) due to the lack of complaints from the patient. The first symptoms appear weakly, so the patient may not pay attention to them at first. The first step is a physical examination. A phlebologist analyzes the patient’s complaints, conducts an examination and determines the causes of varicose veins.

At the initial stage, when the disease is mild, instrumental studies are usually not required. To study the veins, the patient is prescribed a duplex scan, which involves examining the affected area using ultrasound. The examination is carried out using a special device that allows you to obtain a copy of the venous pattern in the area of ​​​​damage, which shows the location of the veins and their affected areas.

In some cases, the phlebologist may prescribe other examinations:

CT scan;

phleboscintigraphy is a method of examining veins based on the use of radionuclide isotopes;

phlebography - fluoroscopy using contrast;

three-dimensional venography - scanning to obtain a three-dimensional image of veins.

Scanning allows you to obtain highly accurate results about the condition of blood vessels and walls, assess their thickness and degree of elasticity. At later stages, a duplex study may be prescribed to confirm the presence of a blood clot in the damaged vessel and establish its location.

Treatment of varicose veins

The course of the disease is easier if the disease is detected in a timely manner and adequate treatment is prescribed.

Based on the information obtained, the optimal method of treating varicose veins is prescribed. Currently, there are several areas of treatment:

conservative treatment;

drug treatment;

minimally invasive intervention;

surgical intervention.

Conservative treatment is prescribed if mild varicose veins and minor damage to the veins are detected, or if there are contraindications to surgical intervention: insufficiency of venous valves, mild varicose veins, or the patient’s refusal to undergo surgery.

The main goal of conservative treatment is to stop the further development of varicose veins. Patients are prescribed special therapeutic exercises against varicose veins, baths and special medications.

Medicines against varicose veins are sold at any pharmacy. It is worth considering that they are not able to restore the previous diameter of the veins and strengthen the walls. The veins remain dilated, but the drugs relieve the main manifestations of varicose veins: pain, swelling and cramps. Drugs for the treatment of varicose veins are called venotonics. This group includes drugs such as Troxevasin, Detralex, Venarus.

Venotonic drugs (gels, ointments, creams, etc.) are intended for local treatment. They do not treat varicose veins, but serve as an additional means of therapy.

Surgical intervention is the main method of radical treatment of varicose veins. Indications for its use are:

the presence of trophic ulcers;

development and progression of blood clots;

retrograde discharge of blood.

There are many methods of surgical intervention; the decision on the choice of method is made by the doctor.

Surgical operations, including those on veins, are accompanied by certain risks. After surgery, there remains the possibility of injury, since when removing a deformed vein, lymphatic vessels and the fat layer are inevitably damaged. Injury to the nerve endings can cause the patient to experience pain for a long time (up to a year). Injury to the lymphatic vessel will lead to the formation of lymph stagnation and swelling.

For these reasons, surgery can only be prescribed if the disease progresses, but in no case to eliminate cosmetic defects such as spider veins.

How to forget about varicose veins forever?

Leg pain limits your movements and full life...

You are worried about discomfort, unsightly veins, systematic swelling...

You may have tried a bunch of medications, creams and ointments...

But judging by the fact that you are reading these lines, they did not help you much...

But there IS a really effective remedy for varicose veins that helps you save 20,000 rubles. during the operation Read more >>>

Surgical (surgical) treatment of varicose veins: is it necessary to have an operation and what kind?

Conservative treatment is not always effective in the fight against varicose veins, therefore, if there is a diagnosis of “advanced varicose veins,” surgery is inevitable and the only way out of this situation. Many patients are pathologically afraid of any surgical intervention, so they put off going to a phlebologist and try to help themselves in non-radical ways. This is one of the reasons that only complicates the course of the disease and aggravates the patient’s condition.

For varicose veins, surgery is mandatory in the following cases:

with extensive advanced disease;

with pathological enlargement of the saphenous veins;

when blood flow through the vessels is disrupted, which leads to constant fatigue and a feeling of heaviness, pain in the limbs;

with trophic lesions of the skin;

with the formation of non-healing trophic ulcers;

with exacerbations of thrombophlebitis.

However, vein removal surgery for varicose veins on the legs may not be recommended for all patients. It is contraindicated in the presence of the following complications and conditions of patients:

in the presence of hypertension;

when contacting a surgeon at a late stage of the disease;

when a patient is diagnosed with ischemic disease;

in the presence of severe infectious processes;

if the patient is elderly;

if the patient has erysipelas, eczema and other similar diseases;

if a woman is pregnant (5 – 9 months of gestation).

Treatment of varicose veins with surgery is considered quite effective and harmless if performed by an experienced phlebolist. You should not risk your health and go on the operating table to a doctor about whom you know nothing. But an experienced doctor, who is fluent in the technique of performing the operation, will be able to remove damaged veins in 1.5 - 2 hours and eliminate the discomfort that they caused to the legs. This suggests that it is necessary to decide in advance where to operate on varicose veins.

How to remove veins for varicose veins, watch a video of the operation filmed in one of the clinics.

Preparing for surgery to remove varicose veins

Surgery to remove varicose veins is called phlebectomy. If the doctor has prescribed it, the patient must prepare for the specified time. A few days before removing varicose veins, the patient is required to pass all tests prescribed by the doctor.

This procedure does not require special preparations on the day of its implementation, but the following activities are mandatory:

take a shower in the morning;

shave the leg on which the operation to remove varicose veins will be performed;

come to the clinic a little earlier than the specified time.

If surgical treatment of varicose veins is decided to be carried out under general anesthesia, the patient is given an enema the day before to cleanse the stomach. Before performing an operation to remove varicose veins and nodes, it is necessary to notify the operating phlebologist about the presence of allergies to medications. During surgical treatment of varicose veins of the lower extremities, novocaine is used for pain relief, and preparations containing iodine are used to treat the wound. The patient must notify the doctor if there is an allergy to these medications. If you are expected to be in the clinic after the operation, then before the operation begins, the doctor receives information from the patient about what medications the patient uses systematically.

Is it necessary to have surgery to remove dilated veins for varicose veins?

Every patient with varicose veins at some point wonders whether to have surgery for varicose veins or endure the pain while it is still possible. Usually this issue should be discussed only with your doctor, focusing on your condition. It is not worth undergoing surgery just because the veins look unaesthetic. You can try to treat them with minimally invasive procedures and medications. In the early stages of the development of the disease, compression hosiery and exercise therapy will help. However, if the disease has reached such an extent that the pain has become unbearable and the phlebologist sees no other way out to eliminate it, then there can be no doubt as to whether surgery for varicose veins is necessary. It is needed and must be done as soon as possible, before serious complications arise.

Types of operations for varicose veins: photos and descriptions

Even an experienced phlebologist finds it difficult to answer the question of which operation for varicose veins is better and more effective. The choice of surgical intervention method depends on the specific case. What may be recommended for one patient may not be suitable for another. The doctor must take into account how the disease manifests itself, how the patient feels, and whether there are complications of the disease. The modern clinic offers several types of operations for varicose veins. Each of them has its own advantages and disadvantages. The same operation, performed by the same phlebologist, will make someone completely healthy, but will help others only for a while. The following is a more detailed story about what types of operations for varicose veins can be offered to a patient, illustrated in photos and videos.

Surgery for varicose veins

Varicose veins are the terrible “plague of the 21st century.” 57% of patients die within 10 years of.

Phlebectomy involves removing veins that are affected by varicose veins. The operation was first performed at the beginning of the 20th century. Over the 100 years of its existence, it has improved significantly. Today, surgery can offer it using the Babcock, Nartu, and Muller methods. These treatment methods are suitable for both the removal of great vessels and the removal of small saphenous veins with nodes. To remove diseased vessels, small incisions are made on the limbs through which the diseased veins are removed.

Vein stripping is a type of surgical removal of varicose veins. This type of treatment is used to remove the great saphenous vein along with its tributaries through an incision in the area of ​​the inguinal fold. Partial stripping involves extracting a part of the vessel with a probe, and total stripping means pulling out the entire vessel by freezing it to a special probe. Perforating veins should be ligated. A tight bandage is applied to the operated limb.

Watch a video of how surgery to remove varicose veins is performed.

Sclerosis of varicose veins

Sclerotherapy is considered a minimally invasive method for treating varicose veins. A special substance called sclerosant is injected into diseased vessels. It acts on the inner wall of the vein, gluing (sclerosing) the vessel. Subsequently, scar tissue forms in its place, and the vessel completely disappears. Sclerotherapy for varicose veins is used not only for varicose veins. This treatment method is used in the presence of varicocele.

There are several types of sclerotherapy for varicose veins:

Echosclerotherapy is used to treat deep veins, the diameter of which reaches 1 cm. The introduction of sclerosant into the vein is carried out under the control of a duplex scanner. A sclerosant is injected into the lumen of the vessel with a needle. Soon its size will decrease and the blood flow will stop.

Sclerosis using the “foam-form” method is carried out using special foam as a sclerosing agent. It fills the lumen of the vessel. The procedure does not cause pain and is completely safe.

A video of surgery for varicose veins on the legs using sclerotherapy is offered for viewing.

Laser treatment of varicose veins: laser coagulation of varicose veins

If the clinic has the appropriate equipment, patients are offered laser treatment for varicose veins. This new medical technology will make it possible to get rid of the disease without incisions of soft tissues and stretching of pathologically altered vessels. Endovasal laser coagulation (EVLC) of varicose veins is carried out using light radiation, which has a wavelength of 1500 nm. A laser light guide is inserted into the vein through a puncture. Radiation enters through it, under the influence of which the diseased vein is coagulated, that is, sealed. Gradually it resolves and disappears. Reviews from patients say that in most cases there are no relapses after laser treatment of varicose veins in the legs.

And here is another video fragment that shows how varicose veins are removed with a laser.

Treatment of varicose veins without surgery: non-surgical methods for treating the lower extremities

Before the disease has time to gain strength, you can try treating varicose veins without surgery. Protruding vessels can be compressed using compression garments. Depending on the degree of manifestation of the veins, the doctor recommends a type of therapeutic knitwear. Traditional medicine offers its own ways to cure varicose veins without surgery. You can use lotions made from yogurt, which is diluted with a decoction of wormwood, compresses from an infusion of hops, an alcohol tincture from dry leaves of Kalanchoe, and dressings with vinegar. Pieces of tomato, cabbage leaves smeared with honey, and raw potatoes are applied to diseased enlarged veins.

At an early stage of the disease, hirudotherapy is considered one of the effective methods of non-surgical treatment of varicose veins. The saliva of these small creatures helps thin the blood, which improves its circulation through the veins. However, this treatment method also has its drawbacks: after a leech bite, a small scar remains.

Blue clay will also help get rid of varicose veins without surgery if you apply it periodically to sore lower extremities in the form of lotions, masks, or make clay baths for sore legs.

Ointments, creams, patches, gels and tablets are also non-surgical methods for treating varicose veins. However, before using any drug, you should consult your doctor.

Varicose veins: rehabilitation after surgery, postoperative period

Varicose veins usually do not return after surgery. However, the frequency of relapses and pain depends not only on the skill of the surgeon who operated, but also on the behavior of the patient, who behaves correctly in the postoperative period. To avoid the formation of hematomas, minor bleeding from healing wounds, and other complications, you must take care of your health and follow all doctor’s recommendations during the rehabilitation period. Let us briefly discuss what to do after varicose vein surgery and what not to do under any circumstances so that the disease no longer reminds you of itself.

Mandatory tight bandaging of the leg with an elastic bandage.

Sports activities taking into account the permissible load calculated by the instructor.

Use of compression stockings for disease prevention.

Avoid heavy lifting.

Watch your own weight.

The first two days after surgery are strictly prohibited :

• drinking alcohol;
• performing heavy physical work;
• taking a hot bath;
• car driving.

In the postoperative period, on days 2–4 after removal of varicose veins and nodes, some patients feel pain in the legs and notice an increase in temperature. You can reduce the pain or remove it completely with the help of massage, which is recommended to be performed independently. It is advisable not to spend a lot of time in bed. Any movements of the legs contribute to the rapid restoration of blood flow and increase the tone of the cardiovascular system.

After surgery for varicose veins of the lower extremities, during the rehabilitation period, patients may be prescribed antiplatelet drugs that will prevent the formation of blood clots. This is Aspirin, Curantil. Heparin injections thin the blood. In the presence of inflammatory processes or to prevent them, antibiotics may be prescribed. Some patients are advised to take pain medication to reduce the feeling of pain.

If surgery was performed, patients were left with stitches at the tissue incision sites. You can remove them after a week, when the wounds have completely healed.

Surgery for varicose veins: consequences and complications

Most operations for varicose veins go well. In such cases, the patient can leave the clinic within a few hours. However, as with any rule, exceptions are possible, and after surgery there may be unexpected troubles. It is useful for patients to know in advance about the possible complications and consequences that occur after surgery to remove varicose veins.

• Bruising may be noticeable for some time after surgery. They usually disappear gradually on their own within a month. In rare cases, their traces are visible for up to 2 – 4 months.
• Skin thickening at the sites of incisions or punctures will also disappear on their own after about the same time as bruises.
• Painful sensations when touching the ankle are observed in cases where the nerve endings are damaged during the incisions. Skin sensitivity returns to normal on its own without additional treatment.
• Swelling appears with heavy loads on the legs in the postoperative period. The patient needs to reconsider physical activity and avoid heavy work.

Ksenia Strizhenko: “How did I get rid of varicose veins on my legs in 1 week? This inexpensive product works wonders, it's a common one. "

Anesthesia for caesarean section

Caesarean section (CS) is one of the most common operations in obstetric practice, used in complicated pregnancy and childbirth, allowing to preserve the health and life of mother and child. Like any surgical intervention, CS surgery requires pain relief. The two most common methods are general anesthesia and epidural anesthesia. What determines the choice of anesthesia? What are the advantages and disadvantages of each? Let's figure it out.

Epidural anesthesia

Epidural anesthesia is a type of regional anesthesia that allows you to eliminate pain in a specific part of the body. In our case, during a cesarean section, in the lower half of the body.

Preparation begins 30-40 minutes before surgery. A sterile needle is used to puncture the skin at the lumbar level and through the intervertebral discs the needle enters the epidural space. The anesthesiologist then inserts a soft, thin plastic tube (catheter) through which the medicine (painkiller) will flow, and removes the needle.

information When the drug begins to act, the woman ceases to feel the lower part of the body: pain, temperature and tactile sensitivity disappears, approximately from chest level to the tips of the toes. At the same time, the expectant mother retains a clear consciousness: she hears, sees everything and can control her condition herself.

• The woman remains conscious and is able to independently control her well-being, which allows her, if any discomfort occurs, to inform the anesthesiologist about it so that he can take measures to eliminate it;
• The relative stability of the maternal cardiovascular system is maintained, which allows avoiding additional administration of other medications;
• The woman in labor breathes on her own, there is no need to intubate the trachea, which means that trauma and irritation of the upper respiratory tract are eliminated;
• If it is necessary to prolong the operation, an additional dose of the drug can be administered through the left catheter, which will allow it to be extended for the required time, and after the operation, narcotic analgesics can be added to facilitate the postoperative period;
• The overall harm to the child from epidural anesthesia is not great due to the lack of many drugs used in general anesthesia. However, depending on what medications were used (only anesthetics or also narcotic drugs), some complications are possible: a decrease in the child’s heart rate, hypoxia, and respiratory failure. With a competent approach from a pediatric neonatologist, all these complications can be easily eliminated.
• Carrying out epidural anesthesia requires a highly qualified doctor, since the lumen of the epidural space is only 5 mm, there is a high probability of affecting the dura mater, which can subsequently lead to severe headaches (2% of cases);
• At least 20 minutes must pass from the time the drug is administered to the start of the operation, which makes it difficult to use this method in emergency cases;
• Sometimes the catheter may be placed unevenly, which can lead to unilateral pain relief and discomfort during surgical procedures. Therefore, before starting the operation, be sure to check sensitivity on both sides and only then proceed with the operation;
• Due to the individual characteristics of the body, isolated damage to the nerve root by a needle or catheter is possible, followed by the occurrence of neurological complications (headaches, which in rare cases can last for several months).

In most cases, this method of pain relief is used in emergency situations or when epidural anesthesia is not possible (there are contraindications or lack of proper technical support). The woman is unconscious throughout the operation and does not feel anything.

General anesthesia for caesarean section is carried out in three stages. First, the woman is given a “preliminary anesthesia” intravenously, allowing her to fall asleep, then the trachea is intubated. A tube is inserted into the lower part of the windpipe, through which oxygen and anesthetic gas will subsequently flow. The third stage is the introduction of muscle relaxants, which relax all the muscles of the body, including the uterus. After this, the operation begins.

• It does not take much time to induce anesthesia;
• Easier and most commonly practiced technique;
• There are practically no contraindications for use;
• Creates excellent working conditions for surgeons and anesthesiologists;
• The condition of the woman’s cardiovascular system during the operation is more stable.
• There is a risk of lung aspiration from gastric contents;
• There may be difficulties with tracheal intubation, its traumatization and, as a result, the occurrence of sore throat, cough, respiratory tract infection, and pneumonia in the postoperative period;
• The large number of drugs administered during general anesthesia can have a negative effect on the mother and affect the baby;
• Anesthetics and narcotic substances used during anesthesia have a depressing effect on the child’s nervous system, resulting in lethargy, lethargy and drowsiness. They can also cause breathing problems in the newborn, which may require resuscitation by a neonatologist.

Which anesthesia should I choose?

At the stage of preparation for a planned caesarean section, in most cases the choice between general anesthesia and epidural anesthesia remains with the expectant mother. However, here it is necessary to take into account the equipment of the maternity hospital and the qualifications of specialists.

important In addition, if there are contraindications to epidural anesthesia (acute infectious diseases, injuries and diseases of the spine, bleeding disorders, oblique or transverse position of the fetus), no matter how much you would like to be present at the moment the baby is born, for the sake of your safety you will not be allowed to do so they can.

Let's summarize and compare these two types of anesthesia.

6 more articles on the topic: Childbirth without pain: what you need to know

At the stage of preparation for a planned caesarean section, in most cases the mother can choose the method of pain relief herself. The two most common are general anesthesia and epidural anesthesia.

When choosing, you need to consider several factors.

• Own strength and psychological readiness. What do you prefer - to fall asleep and wake up in the ward, or to attend your own operation and see the baby immediately after birth?
• Equipment of the maternity hospital in which the operation will take place. It is likely that regional maternity hospitals may not have the equipment to safely perform any method of anesthesia.
• Qualification of doctors and medical staff. Can the anesthesiologist at your maternity hospital guarantee that anesthesia is performed in accordance with all standards?

Both methods can have a negative effect on the child. However, with general anesthesia, the risk of complications is still higher, since not one, but several medications are introduced into the mother’s body at once.

Brief comparison table of general anesthesia and epidural anesthesia

Anesthetic drugs may enter the child’s body and have a depressing effect on the brain.

May cause a decrease in the baby's heart rate, hypoxia, and breathing problems after birth

Mom is in medicated sleep throughout the entire operation.

Mom remains conscious throughout the entire operation

You will be able to see your baby only in a few hours

Immediately after the baby is removed, the mother can look at him and hold him

After waking up from anesthesia, it takes time to recover

Numbness in the legs goes away within a couple of hours after surgery

Cough and headache may occur after anesthesia

Headache and back pain may appear afterwards

Most often, this type of pain relief is used in emergency cases because it requires much less time. Throughout the operation, the woman sleeps and does not feel anything.

General anesthesia consists of three components. In order for the mother to fall asleep, a “preliminary anesthesia” is first administered intravenously. A tube is then placed in the trachea (the lower part of the windpipe), through which a mixture of oxygen and anesthetic gas is supplied. Finally, a muscle relaxant is introduced - a drug that relaxes all the muscles of the body, including the uterus. After such triple anesthesia, the operation begins.

There are practically no contraindications for general anesthesia, but side effects and complications can be quite serious.

Side effects of general anesthesia

• The most common and mild nuisance is coughing and sore throat from irritation from the tube. If performed incorrectly, your voice may become dull. Sometimes there may be injuries to the lips, teeth and tongue due to rough actions of the anesthesiologist.
• Common side effects: headache, nausea, dizziness, confusion, muscle pain;
• More serious complications include respiratory tract infections, pneumonia, allergic reactions, and the depressing effect of anesthetic drugs on the brain.

General anesthesia for cesarean section is indispensable if:

• There are contraindications for epidural anesthesia;
• With oblique and transverse position of the fetus, prolapse of the umbilical cord;
• For emergency caesarean section.

The effect of general anesthesia on a child

General anesthesia has a greater effect on the child than epidural anesthesia. Side effects may include:

• Lethargy, drowsiness of the child;
• Breathing disorders;
• Toxic effect on the brain and the development of perinatal encephalopathy (PEP).

Expert Arkady Kokhan, Anesthesiologist-Resuscitator

For general anesthesia, drugs are used that have a slight suppressive effect on the functioning of the child’s respiratory center. However, the use of modern techniques and proven obstetric techniques helps the child survive the stress of childbirth and minimizes the negative consequences of general anesthesia. If necessary, resuscitation measures are carried out. Parents do not need to take any special actions.

It consists of injecting an anesthetic substance into the place where the nerves exit the spinal cord in the spinal canal. All sensitivity of the lower body disappears: pain, tactile and temperature. The person does not feel his legs below the waist and cannot move them.

With this anesthesia, the mother retains a clear consciousness. She sees and hears everything that happens around her, and can communicate with the doctor or husband (if he is allowed to be present). If desired, you can also use the same method to relieve pain during childbirth.

Most often, epidural anesthesia is used for planned cesarean sections, when doctors have time to prepare. The calmer the situation before the operation, the easier it is for the doctor to make a puncture and the better the anesthesia goes. In emergency cases, this is not always possible, especially when the woman is still having contractions.

Epidural anesthesia technique

Preparation begins 30 - 40 minutes before surgery. A sterile needle is used to puncture the skin above the spine at the lumbar level. When the needle enters the space where the nerve roots of the spinal cord exit, a thin soft tube (catheter) is inserted into it, through which the medicine will be delivered.

Then the needle is removed and only the catheter remains, which is glued to the skin with a plaster, extended and brought along the back up to shoulder level. Now the doctor can inject the required amount of medication into the catheter at any time to obtain an analgesic effect.

If an attempt to puncture and place a catheter for some reason fails, then, as a rule, they proceed to general anesthesia.

Contraindications to epidural anesthesia

• Inflammation of the skin, pustules 20 cm in diameter from the place where the puncture needs to be made;
• Blood clotting disorder;
• Acute infectious diseases;
• Allergy or intolerance to certain drugs for anesthesia (lidocaine, marcaine, etc.);
• Spinal diseases, osteochondrosis with acute pain;
• Scar on the uterus - in some cases;
• Oblique or transverse position of the fetus in the uterus;
• Narrow pelvis or heavy weight of the child.

Side effects and complications of epidural anesthesia

With a caesarean section with epidural anesthesia, side effects and complications are more frequent and more pronounced than with childbirth with it. The fact is that the operation requires much larger doses of medications, and often narcotic drugs (fentanyl) are also used.

Complications largely depend on the skill of the anesthesiologist. In most cases, they are minimal, but discomfort may still occur after surgery. The most common:

• back pain, headache, trembling legs. This usually goes away after a few hours, but if the anesthesiologist makes mistakes (usually due to lack of time), the headache can remain for several days and in rare cases for several months.

More rare complications:

• urinary disorders - occur rarely and usually go away within a few days;
• allergic reactions - may occur in rare cases. The operating room has everything necessary to eliminate them;
• spinal cord or nerve injury - directly depends on the anesthesiologist. It happens very, very rarely and, as a rule, in complex cases.

Some women are afraid of the feeling that numb legs cause, as if they were cut off or they were someone else's.

The effect of epidural anesthesia on a child

This is due to the fact that painkillers can pass from the mother’s bloodstream through the placenta to the baby. Side effects directly depend on what medications are used: it can only be anesthetics (lidocaine, marcaine, etc.) or narcotic drugs (fentanyl, etc.)

• A decrease in the baby’s heart rate is due to a decrease in the mother’s blood pressure and worsening blood flow in the placenta;
• Hypoxia - occurs as a result of a decrease in heart rate;
• Breathing disorders after birth - occur after the use of narcotic drugs and sometimes require ventilation.

With a competent pediatrician-neonatologist, all these complications can be easily overcome.

In general, the harm from epidural anesthesia for a child is much less than with general anesthesia, and there is practically no effect on the brain characteristic of anesthesia drugs.

Epidural anesthesia: what it is, indications and contraindications

Epidural anesthesia is a method of pain relief that is carried out by blocking the nerve endings that transmit pain impulses directly to the brain. Sometimes epidural or peridural anesthesia is called anesthesia, which is not entirely true, since anesthesia turns off consciousness completely, while anesthesia numbs the pain, leaving the person awake. What is the difference between peridural and epidural anesthesia? In fact, these are one and the same thing, these are different names for the same method, varieties of regional anesthesia. To understand what an epidural is, you need to get acquainted with the principle of operation of this method. So, what is epidural anesthesia?

The principle of action and technique of epidural anesthesia

As already mentioned, as a result of this method of pain relief, nerve endings are blocked. Let's take a closer look at how this happens. The spinal cord and its roots are surrounded by the dura mater, around which is the epidural space. It runs along the entire spine. The medicine, entering the epidural space, blocks any transmission of pain impulses, thereby causing analgesia (loss of pain).

The technique of performing epidural or peridural anesthesia must be followed with the utmost precision in order to further avoid complications that may arise for the patient if the anesthesiologist is negligent.

1. Preparing the patient for epidural anesthesia: both psychological and medical. Preparation includes preliminary passing of the necessary tests, such as a general blood test, coagulogram, group test and Rh factor.
2. The anesthesiologist prepares the necessary instruments that will be needed for the operation. These are alcohol swabs, saline solution, a puncture needle, a catheter, an adhesive plaster, and, in fact, the anesthetic itself, which will be injected into the epidural space.
3. The patient takes the desired position, which will allow the doctor maximum access to the spine. Typically, the patient lies on his side with his legs pulled up to his chin as much as possible, or sits with his back arched. By the way, between which vertebrae is epidural anesthesia placed? Typically the catheter is placed between the third and fourth vertebrae.
4. Next, the area of ​​skin where the puncture will be made is treated with an antiseptic and injected with local painkillers to make insertion of the catheter as comfortable as possible.
5. Then, when the patient is completely ready, the doctor makes a puncture with a special needle, which reaches directly into the epidural space. A catheter, a thin silicone tube, is inserted through the needle. The needle is then removed and the catheter is secured with adhesive tape. Now you can administer the medicine.
6. The effect of this pain relief method does not occur immediately; you need to wait about 15-20 minutes. During the operation, the pulse, the functioning of the heart, lungs and respiratory system are constantly monitored. The sensations during epidural anesthesia in patients are usually as follows: the lower part of the body slowly becomes numb and loses sensitivity. With a lower dosage of the drug, a person retains the ability to move, although in any case, this is not advisable.

On our website you can see photos and videos of where to inject and how exactly epidural anesthesia is given.

In what cases is epidural anesthesia given?

The use of this type of pain relief in medicine is usually carried out in three cases:

7. Caesarean section with epidural anesthesia
8. Pain relief during labor and labor
9. Application of postpartum and postoperative sutures
10. Appendix removal
11. Uterus removal
12. Hernia repair (if the hernia is located in the abdominal cavity)
13. Surgeries on the bladder, rectum, prostate gland
14. Various types of urological surgeries
15. Surgical interventions in the perineal area
16. Cardiovascular operations
17. Interventions in the leg area (surgeries on bones, joints and blood vessels)

In general, the use of this method in surgery can be said that it is used in cases where general anesthesia is contraindicated for the patient, for example, due to age.

Epidural anesthesia is used to relieve pain when other methods do not help. For example:

1. Postoperative pain. This is especially true if the operation itself was carried out using the described method. In this case, to get rid of postoperative pain, the doctor can leave the catheter with the incoming medicine for up to several days, if necessary.
2. Used to relieve pain after severe injury
3. If necessary, eliminates back pain
4. For so-called “phantom pain” that occurs in a person after the removal of limbs
5. For severe joint pain
6. Widely used as palliative therapy in cancer patients. This means that the technique does not lead to a cure, but only alleviates the condition.

Drugs for epidural anesthesia

For epidural (peridural) anesthesia, a whole range of different anesthetics is used. Here are examples of these medications:

They all differ somewhat in terms of exposure time, properties, and contraindications. As a rule, the doctor prescribes exactly the anesthetic that is suitable for a particular patient, taking into account all factors, as well as the tests performed. Therefore, even if you are allergic to a certain anesthetic, you don’t have to worry, the specialist will definitely select an alternative.

7. When it comes to obstetrics, the main advantage is the fact that the woman remains conscious during childbirth, listens to the doctor's recommendations and can see her baby immediately after birth. In addition, this type of anesthesia causes the least harm to the fetus while it is still in the womb.
8. If we talk about the method as a whole, covering the entire wide range of its applications, the advantages are the quality, as well as the duration of pain relief. The anesthesia will last until the doctor stops the medication and removes the catheter.
9. In addition, some drugs promote muscle relaxation sufficient for complex operations. This greatly facilitates the surgeon’s work and avoids the use of general anesthesia, which is quite harmful to the body.
10. The use of this particular method ensures stable functioning of the cardiovascular system
11. And, as we have already said, it is possible, without performing any additional manipulations, to make the postoperative period painless for the patient
12. Since the medicine enters the body through a catheter, there is a risk of an overdose of the anesthetic drug. This leads to a sharp decrease in blood pressure, seizures, and depressed breathing.
13. Due to a doctor's mistake, the anesthetic may enter the subarachnoid space. If, when small doses of the drug are administered, this does not significantly affect the patient’s condition, then with prolonged epidural anesthesia, with the installation of a catheter, such a medical error is fraught with cardiac and respiratory arrest for a person.
14. To conduct this particular method of anesthesia, the anesthesiologist must have significant medical training and his skills must be honed. Not every medical institution has such a specialist.
15. In approximately 15% of cases of an epidural, pain relief does not occur completely, or may not occur at all. Naturally, this causes significant discomfort for both the patient and the surgeon. In this case, additional administration of an anesthetic through a vein, or even urgent general anesthesia, may be required.
16. Neurological complications. They can occur as a result of injury to the spinal root caused by a needle or catheter.

Indications for epidural anesthesia

17. Let's start with obstetrics again. Here, indications for the use of an epidural are considered to be a “caesarean section”, too high a pain threshold in a woman in labor, an abnormal course of labor, multiple pregnancies or premature birth.
18. The main indication for epidural anesthesia in other cases is, first of all, the impossibility of performing general anesthesia. For example, if the patient is elderly, general anesthesia may cause more harm than the benefit of the surgery.
19. A sufficiently high blood pressure in the patient is also considered an indication.

Contraindications to epidural anesthesia

20. An absolute contraindication to the use of this type of anesthesia is purulent and inflammatory diseases of the area where the puncture is performed (as we remember, approximately between the third and fourth vertebrae). If a puncture is performed under such conditions, there is a risk that the infection will spread sufficiently to affect areas of the body whose inflammation can lead to very serious consequences.
21. Acute infectious diseases, or exacerbation of chronic
22. An operation with this method of pain relief will not be carried out if the medical institution is not equipped with the necessary equipment. For example, if there is no apparatus for artificial ventilation of the lungs, used in the event that various kinds of complications arise
23. Contraindications in tests that indicate the risk of severe bleeding during puncture: poor blood clotting, low platelets, high white blood cells, etc.
24. Some pathologies and anomalies in the spine itself, such as intervertebral hernia or osteochondrosis, accompanied by severe pain
25. Heart arythmy
26. Low blood pressure. Unlike the indications for using the method for high blood pressure, its low levels serve as a reason for refusing to use an epidural, since with it blood pressure tends to decrease significantly
27. During a “caesarean section” or during childbirth, a contraindication is the refusal of the woman in labor to use such anesthesia

Recovery after epidural anesthesia

Sensitivity to the limbs usually returns within a few hours after stopping the medication. This usually depends on the dosage of the drug administered. According to doctors, after epidural anesthesia, the patient should remain in a horizontal position for 24 hours. Bed rest is also necessary in case of a fairly common complication after using this method - headache. Usually, after a day, and sometimes eight to nine hours, the patient can already get up. But the complexity of the surgical intervention also plays a role here.

How much does epidural anesthesia cost?

Is epidural anesthesia paid or free? It all depends on the specific case. A free epidural is performed for medical reasons, which we discussed above. If a patient (for example, a woman who is about to give birth) decides to choose this method as additional insurance, then the price will be about 7,000 rubles, it all depends on the medical institution.

Reviews about epidural anesthesia

“When I gave birth for the first time, I was given an epidural. Before this, I suffered for about twenty hours, the pain was terrible, but there was no result. They put on an epidural until the cervix opens, especially since the doctor said that this anesthesia also promotes opening. While the effect of the medicine lasted, I slept, gained strength, and when my cervix was almost dilated, the doctor stopped supplying the medicine and I gave birth myself. It seems to me that if the doctor had not decided that it was time to take pain relief, I would not have survived all this.”

“My father needed urgent kidney surgery, but the question of general anesthesia was quite tough, it could not be used. The doctor suggested epidural anesthesia, and we, after thinking, agreed. Everything went quite smoothly, of course, it was a little wild for my father to watch him being operated on behind the curtain, but it was because of the epidural that we significantly reduced the risks to his health!”

Categories : Tips