Expert: Dr Ian Jackson - please note UK based - 11/24/2007

Question
I was wondering where exactly is an epidural placed for pain management during labor? I have had two. The first one I had 4 years ago left my right leg numb for 4 hours after. The most recent one was 1 year ago and it went fine, it was a pump style that I could manage myself. I am having some thoracic back problems(T11 and T12 region)and the doctor has mentioned possible scar tissue build up from past epidurals. I am having numb, tingling legs that go from the tops of my thighs to my knees and occationally down the legs to the top of my toes. I cannot seem to find exact information ,particualarly location of insertion on the spine, to educate myself on this matter. If you could help me at all I would greatly appreciate it:) Thank you!

Answer
Hi Jackie
Mmmm. What specialty is the doctor that is suggesting scar tissue build up after your epidurals?
Sorry but I feel that this is not a diagnosis and is merely using the epidurals as something to blame for your current problems. Indeed we do 'special epidurals' sometimes called a blood patch where we inject 20 mls of the patients own blood into their back. This should cause far more 'scar' tissue than just an epidural but the evidence is that it all gradually disappears and doesn't.
To answer your question an epidural involves putting a little tube into the epidural space in your back - this space lies outside the dura membrane and this gives it its name. Local anaesthetic is passed down the catheter into the epidural space and this numbs the nerves as they pass through this space to get to your legs, tummy etc.
The prolonged numbness you experienced the first time is not unusual when stronger local anaesthetic is used. Your second one used an infusion of a weaker local anaesthetic.
Epidurals in labour are normally sited in your lumbar spine region.
I hope this helps a bit. I'm afraid that both my wife and I suffered with our backs following the birth of our children. This has only improved as they got too big for us to lift and they can now get in and out of the car without our help.
Kind regards
Dr Ian Jackson