Frequently Asked Questions
What is intrathecal analgesia?
Analgesia is a medical term for pain relief. Intrathecal analgesia is one of the pain relief choices for women giving birth. A very small needle goes between the vertebra of the spinal column and into the fluid-filled sac around the spinal nerves, below the level of the spinal cord. Only a small amount of medication is needed because the fluid in the sac is in direct contact with the spinal nerves.
Is this the same thing as a spinal block?
It is similar, but the type and amount of medication is different. The spinal block uses concentrated local anesthetic medications and results in significant numbness throughout your lower body. In contrast, the intrathecal uses small amounts of local anesthetics combined with narcotics. (Local anesthetic means medication that makes just a specific part of your body numb.) So, with the intrathecal, less of your lower body is numb and you can be more involved in the birth process.
Is it dangerous to have an intrathecal? Could I be paralyzed?
The risk of nerve damage or paralysis is extremely rare, but possible. The injection is made into an area of nerves; therefore, it is possible to damage the nerves with the intrathecal needle. But, put in perspective, the risk of such a complication is far less than the risk of death in a car accident on the way to the hospital.
Can everyone have intrathecal pain relief?
No. Intrathecal analgesia is not for all patients. You may not be a candidate for intrathecal analgesia if you:
- are allergic to certain narcotics or local anesthetics
- have a nervous system (neurological) disease
- have a bleeding tendency or blood coagulation disorder
- take aspirin routinely
- have an infection in the lower back
- have a psychological disorder or a fear of needles
- have a spinal deformity
- cannot cooperate or get into a position to allow the anesthetic administration
- are too early in your labor
- are progressing too rapidly, or
- have an abnormal labor or fetal monitoring pattern.
It's important that you be honest and open with your doctor and the anesthetist if you have any of these conditions.
What can I expect if I have an intrathecal?
Most women notice a significant decrease in their pain level within one or two contractions, about five minutes. You can usually remain quite active after an intrathecal, but you might be required to stay in bed if a larger amount of local anesthetic is used. If your intrathecal medication includes local anesthetics to prolong the pain relief, you may notice some slight weakness or tingling of the legs. This is not unusual but you should mention it to your caregiver.
Are there side effects? What are some common problems?
Most of the side effects are normal responses to the local anesthetic/narcotic and disappear as it wears off. You might not be able to go to the bathroom due to the numbness, so you may need to have a catheter to empty your bladder. Depending on the amount of medication, you may be restricted to bed until it wears off. Your blood pressure may drop, which may slow the baby's heart rate. You may develop a headache. You probably will experience some itching. You could have some mild nausea. More rarely, it can cause nerve injury or infection.
How is the intrathecal given? Will it hurt?
The nurse will start an IV so you can be given fluids and medications. The anesthetist and labor nurse will position you correctly for the placement of the intrathecal, either sitting up or lying on your side. Then the anesthetist will apply an antiseptic to your lower back to reduce the chance of infection and give you a shot to numb the ligaments under the skin. You might feel a slight sting and a slight ache until the anesthetic begins to work. When the area is numb, then the anesthetist will actually insert the intrathecal needle. Because your back ligaments will be numb, you will probably just feel some pressure. If you do feel pain, let the anesthetist know, but try not to move during the placement of the intrathecal. Some women experience a strong tingling in the hip or running down a leg. This is not unusual, but you should tell the anesthetist if it happens.
How long does it take to work? What will I feel?
It usually takes less than 15 minutes to place an intrathecal. Pain relief usually begins within one or two contractions, about five minutes. Although you will have significant pain relief very quickly, you may still experience some discomfort and you will be aware of pressure with contractions.
How long will the intrathecal last?
The effects of the intrathecal can last from as little as one hour to as much as seven hours, depending on the amount and type of medications used and how far along you are in the labor process. The average is about 3 hours.
Patients who have had intrathecals often report significant pain relief early in labor, then an increase in discomfort during second stage to delivery, followed by good pain relief after delivery. Although not intended to do so, it often speeds up first stage labor.
When can I have an intrathecal?
It's important that you talk about your pain management wishes during your prenatal visits to the doctor. Once you are in labor, it can be difficult for you to talk about your pain relief options and hard for you to cooperate in receiving medications.
SSM Health St. Clare Hospital - Baraboo physicians and staff prefer to begin the intrathecal only have you have clearly demonstrated progress in labor. For most patients, this is usually when your cervix is dilated to four centimeters. When you can actually have the intrathecal depends on what's happening in your labor and your doctor's professional judgement. When the time is right, the doctor will notify the anesthetist who will talk with you and suggest options in accordance with your wishes and those of your physician. It's important that you ask questions and talk about concerns you may have. Please note that, although it is unlikely, an anesthetist may not be immediately available to administer the intrathecal because of emergencies.
Is it ever too late for an intrathecal?
An intrathecal can be administered later in labor than an epidural. But your labor may be progressing so quickly (particularly after multiple children) that there might not be enough time to give the intrathecal. If it is given just before delivery, the baby might be born sedated or with slower vital signs. Then medication might have to be given to the baby to counteract the narcotics. So intrathecals are usually administered early and when it looks like there will be some time before the actual delivery.
Will my labor be longer because of the intrathecal? Will it cause me to have a C-section?
The pain relief medication will make you feel more comfortable. It will also slow many of the conditions of your labor including your blood pressure, heart rate, and breathing rate. But, there is usually very little effect on your uterine contractions. That means you will likely have contractions with less discomfort, so your contractions can be more effective in delivering the baby. Usually the intrathecal does not affect the length of delivery. It is not intended to speed up delivery, although this happens sometimes. There is no clear evidence that shows that the appropriate use of intrathecal analgesia will result in a higher number of C-section deliveries.
Does the medication affect my baby? Will I be able to breast feed after having an intrathecal?
The amount of medication in your blood stream is influenced by the dose given. The baby is exposed to any medication given to the mother. However, the amount of intrathecal drug that crosses into the baby minimal and is safe for both mother and baby. Your body will eliminate the medications before your breasts begin producing milk for breastfeeding.
Do Intrathecals always work?
Intrathecals usually provide good pain relief, but they may fail to eliminate some or all of your pain. Women vary in their response to medications; sometimes adequate pain relief is not possible.
What are the risks of an intrathecal?
While not common, complications can occur, even though you are monitored carefully and your anesthetists take special precautions to avoid them. Fluids will be given through an IV before the intrathecal is given and while the medications are in effect. This helps keep your blood pressure stable. Shivering is a common reaction. Mild soreness or aching for several days at the site of injection is also normal. Although uncommon, a headache may develop following the procedure. You can help decrease the likelihood of a headache by holding as still as possible when the injection is given. The headache, sometimes lasting a few days, often can be reduced or eliminated by lying flat, drinking fluids, and taking pain tablets. Sometimes when you get a headache it will not go away with the usual treatments. When this happens, the anesthetist will draw some blood from your arm and inject it into your back. This seals the area where the epidural was given and stops your headache. This is called an epidural blood patch. Other complications that can occur include, but are not limited to, infection, nerve damage (including paralysis, loss of bladder and bowel function, and loss of sexual function), allergic reactions, seizures, cardiac arrest, and death. Although the consequences of these complications are very severe, they are also very rare.
How much does it cost?
Due to the risks involved and the high level of training needed for the anesthetist to place it, an intrathecal can be expensive and is not a free service of the hospital. Intrathecal costs are generally one fixed rate and are not depending on technical difficulties or the length of time required to place them. Very few insurance companies pay the total charge. If you are unsure of your coverage, please speak with your insurance company. If you are concerned about cost, then talk with your doctor about the many other options you have for pain management during labor and delivery.
What is the difference between an intrathecal and an epidural?
An intrathecal is an injection of narcotics (and sometimes small amounts of local anesthetics) into the spinal fluid, which is in direct contact with the spinal cord. An epidural is an injection or infusion of local anesthetic/narcotic mixture into the epidural space, where the nerves come out of the spinal canal to the various parts of the body. Both techniques produce excellent pain relief by temporarily reducing the function of the sensory nerves. Each technique has its pros and cons. Please see Epidurals: Frequently Asked Questions to make a full comparison of the two techniques. Ask your doctor for further explanation.
The material above was gathered from a number of websites available to the general public including the public information site of the American Association of Nurse Anesthetists, the Yale-Newhaven Hospital maternity site, and many others. Additional material was obtained while in clinical practice at the May Clinic and while in private practice. All information is intended for your general knowledge and is not a substitute for medical advice or treatment.