Epidural anaesthetic (Epidural anaesthesia)
A fine tube placed in your back by an anaesthetist through which numbing and pain-relief medicines can be given and topped up, to numb part of your body during and after an operation.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An epidural uses a fine tube in the back to give and top up numbing and pain-relief medicines during and after an operation.
- It is a needle and a soft tube in the back, not a surgical cut, and leaves no scar; the tube can stay in for days for pain relief.
- It can give excellent pain relief and may reduce some complications after major surgery, but it does not always work perfectly.
- Specific points to understand are low blood pressure, a treatable headache, the chance it needs adjusting, and rare nerve injury.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Gives strong, adjustable pain relief during and for days after major surgery
People taking certain blood thinners or with a bleeding tendency, where an epidural could risk bleeding around the spine, unless safely managed.
The epidural provides pain relief, topped up by staff or a pump. Your blood pressure, legs and bladder are monitored, and you may have a urinary catheter.
Regular review by an acute pain team or anaesthetist to keep pain relief effective and safe.
The epidural provides pain relief, topped up by staff or a pump. Your blood pressure, legs and bladder are...
Your legs may feel heavy or weak and you may need help to move safely. Staff check the block is at the right level...
Removing the soft tube is usually quick and usually not painful. Numbness and leg weakness wear off over a few...
Any mild backache or bruising at the site settles. Watch for a headache that is worse sitting or standing, or any...
What is an epidural anaesthetic?
An epidural is a way of numbing part of your body and controlling pain using a very fine, flexible tube placed in your back by an anaesthetist. Through this tube, local anaesthetic and pain-relieving medicines can be given and, importantly, topped up over time. This guide is about epidurals used for surgery and surgical pain relief, though the same technique is widely used in childbirth.
The tube sits in the epidural space, just outside the covering of the spinal nerves, low down in the back. Placing it involves a needle in the back to position the tube; this is not a surgical cut and does not leave a scar. The tube can stay taped in place after the operation so pain relief can continue, either topped up by staff or through a small pump.
An epidural can be used as the main anaesthetic for some operations (so you stay awake or lightly sedated), or alongside a general anaesthetic to give strong pain relief during and after surgery. There is good evidence it can reduce some complications, such as chest infections and blood clots, after major surgery in suitable people.
Like all anaesthetics, an epidural is generally safe but not without risks. The specific things to understand are a headache that can follow it, low blood pressure, that it does not always work perfectly, and rare nerve injury.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Epidural compared with spinal anaesthetic
| Epidural | Spinal | |
|---|---|---|
| How given | Fine tube left in the back | Single injection, no tube |
| How long it lasts | Can be topped up for days | Single dose, wears off in hours |
| Onset | Builds up over many minutes | Numbness within minutes |
| Main use here | Surgery plus days of pain relief | Numbness for one operation |
| Shared risks | Headache, low blood pressure, rare nerve injury | Headache, low blood pressure, rare nerve injury |
The two are sometimes combined. Your anaesthetist will advise which suits your operation and your need for pain relief afterwards.
Preparing for your treatment
- Attend your pre-operative assessment so your health is checked and the safest anaesthetic and pain-relief plan is made.
- Follow the fasting instructions, as a general anaesthetic might also be used.
- Tell the team about all your medicines, especially blood thinners or anti-platelet drugs, as these affect whether an epidural is safe.
- Mention back problems, previous spinal surgery, or difficulty sitting or lying still.
- Mention allergies and any past problems with anaesthetics.
- Ask how your pain relief will be managed after the operation while the tube is in place.
- Plan for staying in hospital while the epidural tube is in, and for help when it is removed.
- Bring your questions; you will meet your anaesthetist beforehand to discuss the plan and consent.
What happens
Before the operation the anaesthetist reviews your health, explains the plan and answers questions. A cannula is placed in your hand or arm and monitors track your heart rate, blood pressure and oxygen.
You are asked to sit up or curl on your side and keep still while your back is cleaned. Local anaesthetic numbs the skin, then a needle is used to find the epidural space in your back and a fine, flexible tube is threaded through it. The needle is removed, leaving the soft tube taped securely in place. You may feel pushing or a brief odd sensation; tell the anaesthetist if you feel a sharp or shooting pain.
Medicine is given through the tube and the numbness builds up over several minutes; the anaesthetist checks it is working. Your blood pressure can drop, so it is monitored and treated as needed. Depending on the plan, you stay awake, have sedation, or are given a general anaesthetic as well.
After surgery, the tube usually stays in to deliver pain relief, topped up by staff or a pump, sometimes with a button you can press for safe extra doses. When it is no longer needed, the tube is gently removed; the numbness and any leg weakness wear off over a few hours.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- People taking certain blood thinners or with a bleeding tendency, where an epidural could risk bleeding around the spine, unless safely managed.
- Active infection at the tube site, or some serious heart conditions, may make an epidural unsuitable.
- Some spine conditions or previous spinal surgery can make placement difficult or inadvisable.
- Situations where the pain-relief benefit does not justify the technique, or where a simpler method would do.
Delay or rearrange if…
- You are taking blood-thinning medicine that has not been safely managed around the procedure.
- There is an infection at or near the tube site, or a fever.
- Your blood pressure or fluid balance is unstable.
- Key information, such as a clotting result, is missing.
Alternatives to discuss
- A general anaesthetic with other forms of pain relief, such as injections or a drip.
- A spinal anaesthetic for a single operation, or a combined spinal-epidural.
- A regional nerve block targeting the specific area, sometimes with a tube for top-ups.
- Patient-controlled pain relief through a vein after surgery.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Gives strong, adjustable pain relief during and for days after major surgery
- Can let you stay awake for some operations, avoiding a full general anaesthetic
- May reduce some complications after major surgery, such as chest infections and blood clots, in suitable people
- Can reduce the need for strong painkillers and their side effects
- Pain relief can be fine-tuned and topped up to your needs
- Can help you breathe deeply, move and recover more comfortably after big operations
Risks & complications
- A drop in blood pressure causing faintness or sickness, which is treated
- Numbness, heaviness or weakness in the legs while the epidural is working
- Difficulty passing urine, often needing a short-term catheter
- Itching or shivering
- The epidural not numbing every area evenly, sometimes leaving a patch of pain
- The epidural not working well enough, needing adjustment, re-siting or another method
- A headache afterwards (post-dural-puncture headache) if the covering of the nerves is accidentally punctured; this can be severe but is treatable
- Backache around the tube site for a few days
- The tube coming out or needing to be replaced
- Temporary nerve damage causing numbness, tingling or weakness, usually recovering over days to weeks
- Permanent nerve damage, which is very rare
- Infection or bleeding around the spine (such as an abscess or blood clot pressing on nerves), which is very rare but serious and needs urgent treatment
- A severe allergic reaction to the medicines
- Very rarely, medicine spreading too widely and affecting breathing or blood pressure, which the anaesthetist manages
The points people most want to understand are that an epidural may not work perfectly and can need adjusting, that low blood pressure is common and managed, that a headache can follow it (and is treatable), and that serious nerve injury is very rare. Tell your anaesthetist about any blood thinners, back problems or bleeding tendencies. While the tube is in and afterwards, report any worsening leg weakness, numbness around the back passage, loss of bladder or bowel control, severe headache, or back pain with fever straight away.
Published figures to discuss
Many effects of an epidural are common but manageable, such as low blood pressure and leg heaviness; the serious risks are rare. The Royal College of Anaesthetists publishes cautious figures and stresses that risk varies with your health, the operation and the technique. Headache risk relates mainly to accidental puncture of the nerve covering, and permanent nerve injury is very rare. The figures below are drawn cautiously from RCoA patient information and should be treated as approximate.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Low blood pressure during the epidural | Very common | Expected and routinely treated by the anaesthetist with fluids and medicine. | Guide sourcesClinical context |
| Headache from accidental dural puncture | Uncommon — accidental puncture happens in roughly the order of around 1 in 100 epidurals, and a headache often follows when it does | Treatable; a blood patch is highly effective if simple measures are not enough. | RCoA — Headache after a spinal or epidural anaestheticrcoa.ac.ukPublished figure |
| Permanent nerve damage | Very rare — RCoA patient materials describe figures around 1 in 50,000 or rarer | Temporary nerve symptoms are commoner and usually recover; permanent harm is very unusual. | RCoA — Epidural anaesthesia during and after surgeryrcoa.ac.ukPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no surgical wound from an epidural, just a small tube site in the back. Afterwards, the focus is on managing your pain while the tube is in, then waiting for the numbness and any leg weakness to wear off once it is removed, while watching for the specific warning signs.
- Heavy or weak legs while the epidural is working
- A short period needing a urinary catheter
- Tingling as feeling returns after the tube is removed
- Mild backache or a small bruise at the tube site
- Feeling faint or sick if blood pressure dips, which is treated
Aftercare
- Do not try to walk unaided until staff confirm your leg strength and sensation have returned.
- Tell staff about any pain that breaks through, so the epidural can be adjusted.
- Tell staff if you cannot pass urine, as you may need a catheter.
- Keep well hydrated and take simple pain relief as advised once the epidural is stopped.
- Report a headache that is worse sitting or standing and better lying down.
- Seek urgent help for worsening leg weakness, numbness around the back passage, or loss of bladder or bowel control.
- Watch the tube site for increasing back pain, redness, swelling or fever.
- Follow the aftercare for the operation itself.
- A clear plan for pain relief while the tube is in and after it comes out
- Staff confirmation that your legs are safe before you walk
- Knowing the headache warning sign and what to do
- Knowing the urgent nerve and infection warning signs
- Simple pain relief and fluids for after the tube is removed
- The ward or clinic contact number saved
- Aftercare instructions for the operation itself
Scars and how they heal
An epidural is given through a needle and a soft tube, not a surgical cut, so there is no scar. You may have a small puncture mark or bruise on your back where the tube was, which fades within days.
⚠ Get urgent help if…
- Worsening weakness or numbness in your legs, especially if it returns or increases after the epidural is stopped — seek urgent help
- Numbness around the back passage or genitals, or loss of bladder or bowel control — seek urgent help
- A severe headache that is worse sitting or standing and better lying down
- Increasing back pain with fever, or redness, swelling or discharge at the tube site (possible infection)
- Difficulty breathing, or swelling of the face, lips or tongue (possible allergic reaction) — call 999
- Being unable to pass urine despite a full bladder
- Any warning sign related to your operation
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is an epidural that gives reliable pain relief, helps you move and breathe comfortably after surgery, and wears off cleanly with no lasting effects. After major surgery, good pain control can make a real difference to early recovery.
An epidural supports the operation and recovery but does not change the operation's result. It does not always work perfectly, and may need adjusting, re-siting, or backing up with other pain relief; your anaesthetist will discuss this possibility beforehand.
An epidural is used for a limited time, from the operation until pain relief is no longer needed, usually a few days. Its effects wear off within hours of stopping the medicine, and almost everyone has no lasting effect. A headache, if it happens, usually settles within days, sometimes with treatment. Serious longer-term effects, such as permanent nerve injury, are very rare.
Related tests, treatments or support
An epidural is often combined with a general anaesthetic for major surgery, providing pain relief during and after the operation. It can also be combined with a spinal (combined spinal-epidural) for fast numbness plus top-up pain relief. Your anaesthetist will explain the combined plan and why it suits you.
Follow-up & long-term care
While the epidural is in, an acute pain team or the anaesthetic team usually reviews you to keep pain relief effective and safe. After the tube is removed, most people need no specific follow-up. If you develop a headache or any nerve symptoms, these should be reviewed promptly, in hospital by the team or after discharge by contacting the team or your GP.
Repeat, follow-on and what comes next
- An epidural does not always work perfectly and may need adjusting, re-siting, or backing up with other pain relief.
- The tube can come out or need replacing.
- If a headache develops, it may need review and sometimes a blood patch.
- Any nerve symptoms should be assessed, and most settle without further treatment.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Regular review by an acute pain team or anaesthetist to keep pain relief effective and safe.
- Monitoring of blood pressure, leg strength and the tube site while the epidural is in.
- Clear written warning signs for headache, infection and serious nerve symptoms.
- A named contact and prompt review if a headache or nerve symptoms develop.
- Joined-up care between the anaesthetic team and your GP after discharge.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The anaesthetist's fee, reflecting the length and complexity of the operation
- Whether the epidural is the main anaesthetic or added to a general anaesthetic
- Ongoing pain-relief management, such as an acute pain team and any pump, while the tube is in
- Monitoring and nursing care needed while the epidural is in place
- Your overall health and the length of hospital stay
- Whether the anaesthetist's fee is included in your overall surgical package or charged separately
- Who manages your pain relief while the epidural tube is in place
- Whether monitoring and any pain pump are included
- Whether follow-up by an acute pain team is included after major surgery
- What happens, clinically and financially, if the epidural needs re-siting or another method is used
On the NHS? An epidural is standard NHS care for many operations and in childbirth, and is also used privately; it forms part of the cost of the operation rather than a separate self-pay treatment.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Promising perfect pain relief when an epidural can leave a patch of pain or need adjusting.
- Not explaining the headache and rare nerve-injury risks specific to epidurals.
- Not asking about blood thinners, back problems or bleeding tendencies.
- Not giving clear urgent warning signs, such as worsening leg weakness or loss of bladder control.
- Confusing a tube in the back with a surgical procedure that leaves a scar.
Marketing red flags
- Promising an epidural will give complete, guaranteed pain relief.
- Calling it risk-free or without risks rather than generally safe but not without risk.
- Skipping discussion of the headache, blood-pressure and nerve risks.
- Not explaining who manages your pain relief and recovery while the tube is in.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is an epidural the main anaesthetic for my operation, or for pain relief alongside a general anaesthetic?
- How will my pain relief be managed and reviewed while the tube is in?
- What are my particular risks, including of headache or nerve problems?
- What happens if the epidural does not work well enough?
- How will my blood pressure, legs and bladder be looked after?
- What symptoms should make me seek urgent help while the tube is in or after it comes out?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will I be awake with an epidural?
What is the difference between an epidural and a spinal?
Does an epidural always work?
Can an epidural cause a long-term bad back or nerve damage?
Will I be able to move and pass urine?
How is the tube taken out?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: RCoA — Epidural anaesthesia during and after surgery RCoA — Headache after a spinal or epidural anaesthetic RCoA — Nerve damage after a spinal or epidural anaesthetic RCoA — Epidural anaesthetics: risks and side effects NHS — Epidural
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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