Epidural - Too Many Variations To Consider?

d.cubed

I am obviously not planning on having an epidural, as I'll be at home; however, since I cannot plan exactly the direction of my labor, I try to do research on all of the interventions.  If I do need to go to the hospital for some reason, I want to have a game plan.

So, here's my main problem with the epidural - it's not standardized.  Please correct me if I'm wrong, but every anesthesiologist gets to make up his/her own concoction of drugs that constitute an "epidural" right?  How can we truly study the safety or efficacy of something that varies from physician to physician?  I just want to know if I'm reading into this correctly.  Everything that I come across basically states, "An epidural can consist of drugs x, y, z, h, w..." There seems to be a lot of variation to that formula...  

MissyOlivePants

Really????  I didn't know that....now I'm intrigued (and I thought I had researched it all!)

honkytonk_kid

d.squaredII:

I am obviously not planning on having an epidural, as I'll be at home; however, since I cannot plan exactly the direction of my labor, I try to do research on all of the interventions.  If I do need to go to the hospital for some reason, I want to have a game plan.

So, here's my main problem with the epidural - it's not standardized.  Please correct me if I'm wrong, but every anesthesiologist gets to make up his/her own concoction of drugs that constitute an "epidural" right?  How can we truly study the safety or efficacy of something that varies from physician to physician?  I just want to know if I'm reading into this correctly.  Everything that I come across basically states, "An epidural can consist of drugs x, y, z, h, w..." There seems to be a lot of variation to that formula...  

I'm not planning on getting one either, but to be fair it's not like they are making it up out of nowhere. There isn't one standard epidural med jut like there isn't one standard heartburn med or nausea med or blood pressure med, etc.  Most doctors (from anesthesiologists to family practice doctors) have meds they prefer for a variety of reasons. I don't see why anesthesiologists would be any different.

d.cubed

honkytonk_kid:

d.squaredII:

I am obviously not planning on having an epidural, as I'll be at home; however, since I cannot plan exactly the direction of my labor, I try to do research on all of the interventions.  If I do need to go to the hospital for some reason, I want to have a game plan.

So, here's my main problem with the epidural - it's not standardized.  Please correct me if I'm wrong, but every anesthesiologist gets to make up his/her own concoction of drugs that constitute an "epidural" right?  How can we truly study the safety or efficacy of something that varies from physician to physician?  I just want to know if I'm reading into this correctly.  Everything that I come across basically states, "An epidural can consist of drugs x, y, z, h, w..." There seems to be a lot of variation to that formula...  

I'm not planning on getting one either, but to be fair it's not like they are making it up out of nowhere. There isn't one standard epidural med jut like there isn't one standard heartburn med or nausea med or blood pressure med, etc.  Most doctors (from anesthesiologists to family practice doctors) have meds they prefer for a variety of reasons. I don't see why anesthesiologists would be any different.

Where the difference lies is that heartburn medication and nausea medications have all been approved with certain chemical ratios by the FDA.  Your doctor does not go into the back room and whip up a new medicine because he/she's found that 1/3 Prilosec + 1/3 Previcid + 1/3 Aciphex, works great, or, at least, I don't believe that they're supposed to...  It seems, however, than in terms of an epidural an anesthesiologist can do just that:  

"Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine,chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics, such as fentanyl and sufentanil, to decrease the required dose of local anesthetic. This way pain relief is achieved with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural?s effect or stabilize the mother?s blood pressure."

It seems that there are a lot of different combinations that can be created from the above chemicals, and that there's no standardization. How can we know how safe something really is if there are so many formulas?

sstephen27

All anesthesiologists are going to have opinions on what works best just as your doctor might prefer to describe one sort of antibiotic over another for different reasons.  The thing to worry about is if they are using one brand over another simply because they are being compensated by drug companies rather than what works best as many doctors are prone to do.  Anything they give you will be approved by the highest powers and will be safe unless there is something you're allergic to that they don't know about (which is why they ask you a thousand times what you're allergic to). 

I'm also sure they change amounts of certain things depending on your weight and previous reactions to anesthesia.

erinms

I think you could get more specific information, I don't think it is a total crapshoot.  I think your source is just typical of most medication/drug/disease medical write-ups.  For example (From the Mayo clinic website about antacids, I didn't even get into PPIs or H2 blockers): 

"Antacids are taken by mouth to relieve heartburn, sour stomach, or acid indigestion. They work by neutralizing excess stomach acid. Some antacid combinations also contain simethicone, which may relieve the symptoms of excess gas. Antacids alone or in combination with simethicone may also be used to treat the symptoms of stomach or duodenal ulcers.

With larger doses than those used for the antacid effect, magnesium hydroxide (magnesia) and magnesium oxide antacids produce a laxative effect. The information that follows applies only to their use as an antacid.

Some antacids, like aluminum carbonate and aluminum hydroxide, may be prescribed with a low-phosphate diet to treat hyperphosphatemia (too much phosphate in the blood). Aluminum carbonate and aluminum hydroxide may also be used with a low-phosphate diet to prevent the formation of some kinds of kidney stones. Aluminum hydroxide may also be used for other conditions as determined by your doctor.

These medicines are available without a prescription. However, your doctor may have special instructions on the proper use and dose of these medicines for your medical problem.

Make certain your health care professional knows if you are on a low-sodium diet. Some antacids contain large amounts of sodium.

This product is available in the following dosage forms:

• Liquid
• Tablet
• Powder for Suspension
• Suspension
• Tablet, Chewable
• Capsule
• Solution
• Tablet, Extended Release
• Wafer
• Tablet, Effervescent
• Granule
• Powder, Effervescent"

And yes, a gastroenterologist would recommend that you use a PPI or H2 blocker in combination with effervescent antacid or magnesium antacid or calcium antacid or any other type of combination, depending largely on the experiences they have with those medications but also depending on the symptoms you are having. 

 

My point is that I think you got information about all of the different types of medications that can be used as epidural anesthetics, but that doesn't tell you what is usually used.  I don't think that each anesthesiologist just whips up their own special cocktail of epidural analgesics.  I think most hospitals probably have standardized protocols that largely dictate exactly what medications are used for epidural analgesics.  Then, the other combination meds come into play (epinephrine, etc.) when they are needed (ex: to increase blood pressure if there is a drop after the epidural is placed).  

 

Do you know what hospital you will deliver at if you make the decision to transfer from home?  I delivered at Alta Bates and they have a free anesthesiologist information night.  You can go and learn about all of the pain control medications available and it is led by one of the anesthesiologists, who I am sure would be able to give you more specific information about what is usually used at your hospital.  That might be helpful so that you feel like you know what is most likely going to be used if needed.  

Not that you will need it!  Total positive thoughts for a wonderful homebirth! 

 

d.cubed

Thanks, ladies!  This has been a very interesting conversation!  I'll definitely go to the anesthesiologist night at Alta Bates to ask what their normal protocol is - not that I hope to ever be on the receiving end of it!  

roundtheworldgirl

MissyOlivePants:

Really????  I didn't know that....now I'm intrigued (and I thought I had researched it all!)

This!

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