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Can tubal reversal be done with epidural?

Tubal Reversal Anesthesia
Can Tubal Reversal Be Done With An Epidural?

Can tubal reversal be done with epidural anesthesia?

This is a common question asked by women considering tubal ligation reversal surgery. Understandably many women are fearful of general anesthesia or being ‘put to sleep’.
Many women have had personal experiences with epidural anesthesia during childbirth and would like to avoid general anesthesia if possible.

Although tubal reversal can be done with an epidural, our experience has demonstrated reversal surgery under general anesthesia is safer, has fewer side effects, and helps keep surgery affordable and outpatient.

Although epidurals are safe, epidurals are better for patients who will be hospitalized overnight.

What is an epidural?

Epidural anesthesia for tubal reversal

Anesthesia being injected into the epidural space near the spinal cord.
   Image complements of staff. “Blausen gallery 2014”. Wikiversity Journal of Medicine 1 (2). doi:10.15347/wjm/2014.010. ISSN 20018762

An epidural is a form of anesthesia that uses a small tube (catheter) to administer anesthesia around the nerves in the spinal canal.

To place an epidural a doctor must insert a needle through the skin, between the vertebral bones, and into the spinal column.

A smaller catheter is placed into the larger needle and the catheter is inserted into the spinal column. The needle is then removed and the catheter is allowed to remain during surgery.

An epidural catheter sits next to the dura, or covering, of the spinal nerves. This catheter slowly infuses anesthesia around the dura and this medication diffuses into the spinal nerve compartment. In comparison, spinal anesthesia involves injection of anesthesia into the spinal nerve compartment.

The main benefit of an epidural is anesthesia can be given continually through the catheter and patients can avoid side effects of general anesthesia.

Epidurals are preferred for c-sections because it spares the baby from exposure to general anesthesia.

Tubal reversal and epidural risks

Although patients are familiar with epidurals, many patients are not aware surgeries done under epidural anesthesia often require an overnight hospital stay to monitor for epidural related side effects.

There are three main risks with an epidural when used for tubal reversal surgery:

  • Incomplete pain block
  • Epidural headache
  • Urinary retention

Tubal reversal and epidural: Inadequate pain relief
If an epidural catheter is not inserted properly patients may not be completely numb at the start of surgery. They may feel pain. This often prolongs the surgery or results in abandoning the inadequate epidural and either attempting to insert another epidural or giving general anesthesia.

Tubal reversal and epidural headaches
An epidural headache is caused when spinal fluid leaks from the epidural puncture site in the spinal canal. When this happens patients will experience a very severe headache and will be unable to sit up or walk. This is often not recognized until the night of or the day after surgery. Epidural headaches can be treated but require a blood patch (injection of blood into the spinal canal to patch up the hole).

Diagnosing and treating epidural headaches increases the amount of time it takes patients to recover from surgery. Patients who have epidural anesthesia are hospitalized overnight to monitor for this unique epidural risk.

Epidurals and tubal reversal: Urinary retention
Urinary retention is a risk of epidurals. The bladder is often the last muscle to recover from the paralyzing effects of epidural anesthesia. Sometimes the epidural will cause prolonged bladder paralyzation and patients may not be able to void (pee) after an epidural.

Patients who are unable to void after surgery will require a bladder catheter for several days to allow the bladder to recover from this epidural risk.

Can epidurals be used for tubal reversal surgery?

Although epidurals can be used for tubal reversal surgery, epidurals are not ideal for outpatient surgery. Patients with epidurals need to be hospitalized overnight to be monitored for epidural complications.

Since insurance does not pay for tubal reversal surgery, epidurals for tubal reversal only increase the cost of tubal reversal surgery and require overnight hospitalization.

For more information: Tubal ligation reversal anesthesia: Best anesthesia for reversal surgery

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