Anaesthesia · UK patient guide
Epidural anaesthetic and analgesia, explained honestly.
The same technique underpins the gold-standard pain relief for labour and the reference-standard analgesia after major abdominal, thoracic and vascular surgery. Here is what an epidural is, how it feels, and what the risks really are.
Why patients choose us
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A consultant anaesthetist, at the bedside
Whether it is your labour or your surgery, the block is placed by a named consultant anaesthetist — not delegated to a trainee working alone.
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Obstetric and peri-operative — both covered
The same technique underpins pain relief in labour and after major abdominal, thoracic or vascular surgery. We explain the version that applies to you.
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Honest on the risks
Failed blocks, dural puncture, and the rare serious injuries quoted from the RCoA NAP3 audit — spoken about openly before you consent.
Indicative pricing
What a private epidural costs in the UK.
For obstetric use, the epidural fee usually sits inside a wider private-maternity package. For surgery, it is part of the anaesthetic bill. Ranges below are illustrative.
In short
A private labour epidural in London typically costs £1,200–£2,400, on top of the maternity package.
| Type | Indicative range | Set-up time | In use |
|---|---|---|---|
| Obstetric labour epidural (private maternity) | £1,200–£2,400 | 20–30 min set-up | Continuous through labour |
| Combined spinal-epidural (CSE) in labour | £1,400–£2,800 | 20–30 min | Faster onset than epidural alone |
| Epidural for elective LSCS conversion | Included in LSCS package | 10 min top-up | Same visit |
| Thoracic epidural for open abdominal surgery | £1,600–£3,200 | 30 min set-up | Catheter in 2–4 days |
| Thoracic epidural for thoracotomy | £1,800–£3,600 | 30 min | Catheter in 2–4 days |
| Anaesthetic consultation only | £250–£450 | 30 min | Same visit |
Prices vary by hospital, anaesthetist and case complexity. NHS obstetric and peri-operative epidurals are free at the point of care. Private figures above are for guidance only — we confirm a firm quote before you commit.
The problem
The right block, at the right level, by the right anaesthetist.
Epidural is a specialist technique with specialist risks. The three things worth getting right are informed consent, an experienced operator, and a plan for the rare things that can go wrong.
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Weighing epidural vs alternatives
Spinal, remifentanil PCA, gas and air, peripheral nerve block — an anaesthetist walks you through each before you decide.
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Worried about the risks?
The numbers are quoted from the UK NAP3 audit and the OAA — not softened, not overstated.
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Post-procedure headache or weakness?
We arrange same-day anaesthetic review for post-dural-puncture headache or any new neurological symptom.
The journey
From enquiry to catheter out — what happens, in order.
One anaesthetic team from the pre-assessment through to the neurological check after the catheter comes out.
Phase 1 · Before
Pre-assessment and consent
Phase 2 · Placement
In the labour room or anaesthetic room
Phase 3 · After
Removal and neuro check
- 01
Before
You tell us what is coming up
A short, confidential form. Whether it is a planned birth, an elective operation, or a question about epidural for chronic surgery recovery.
- 02
Before
We come back with a plan
Within one working day: the type of epidural (labour or peri-operative), how consent works, and what to expect on the day.
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Before
Anaesthetic pre-assessment
Bloods and a review of any anticoagulants or spinal history. Nothing is stopped without an anaesthetist agreeing it is safe.
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Placement
Positioning and the block
You sit or lie curled. Skin is cleaned, local anaesthetic given, and a fine catheter placed via a Tuohy needle using loss-of-resistance.
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Placement
Test dose and top-up
A small test dose confirms the catheter is in the right space. The working dose follows — low-dose bupivacaine with fentanyl in labour, stronger mixes for surgery.
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Placement
Monitoring and PCEA
Blood pressure, block height and fetal or surgical monitoring are continuous. Many units allow patient-controlled top-ups (PCEA).
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After
Catheter removal and review
Removed after birth, or kept in 2–4 days for post-op analgesia. Any headache, weakness or back pain is reviewed the same day.
Placement: 15–30 minutes. Labour epidural removed after birth; peri-operative catheter usually in for 2–4 days.
When it helps
When an epidural is the right choice.
The situations we see most in UK maternity and peri-operative practice, plus the red flag that means an emergency rather than an appointment.
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Labour analgesia (obstetric)
The gold-standard pain relief in UK maternity units — used in around one in three UK labours, at any dilation once labour is established.
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Elective caesarean top-up
A working labour epidural can be topped up to surgical strength if a Category 2 or 3 LSCS becomes necessary.
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Open abdominal surgery
Whipple, oesophagectomy, open colorectal or hepatobiliary work — thoracic epidural is often part of an ERAS pathway.
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Thoracotomy and lung surgery
Post-thoracotomy pain is severe; thoracic epidural remains a reference standard for the first few days.
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Open aortic and vascular surgery
Epidural analgesia helps early mobilisation and can reduce respiratory complications after major vascular work.
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Major orthopaedic (selected)
Hip and knee arthroplasty more often uses spinal or peripheral nerve block, but epidural is used for revision or bilateral cases.
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Combined spinal-epidural (CSE)
Rapid onset from the spinal component with the continuous analgesia of an epidural catheter — useful in advanced labour.
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Red flag: sudden severe back pain or weakness
New severe back pain, leg weakness or a numb bottom after an epidural is not normal — call the on-call anaesthetist the same hour.
Types of epidural
Not every epidural is the same.
The catheter is the same idea in every case, but the level, drug mix and monitoring are tailored to whether it is for labour, caesarean, or major surgery.
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Low-dose mobile epidural (labour)
Bupivacaine 0.1% with fentanyl — enough to remove the pain, little enough that most women can still move their legs.
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Patient-controlled epidural (PCEA)
A pump lets you press for top-ups within safe limits. Less midwife-called top-ups, similar total dose, better satisfaction in trials.
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Combined spinal-epidural (CSE)
A single-shot spinal for near-instant pain relief plus a catheter for continuous cover — the workhorse when things are moving quickly.
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Epidural top-up for LSCS
The catheter already in for labour is loaded with a stronger local to give surgical anaesthesia for a caesarean.
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Thoracic epidural (T4–T10)
A higher-level catheter placed between the shoulder blades or mid-back, tailored to the surgical incision.
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Lumbar epidural for major surgery
For lower abdominal, pelvic, or lower limb surgery where a thoracic level is not required.
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Epidural blood patch (post-DPH)
A small volume of your own blood placed into the epidural space to treat a post-dural-puncture headache.
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Anaesthetic consultation only
An honest discussion of options — epidural, spinal, remifentanil, gas and air, peripheral blocks — before any decision.
Our vetted UK network
Consultant anaesthetists, audited units.
Obstetric and peri-operative anaesthetists across London and the home counties, working in units audited against RCoA and OAA standards.
Selection criteria
How we choose every anaesthetist in our network.
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Consultant anaesthetists on the obstetric or peri-operative rota
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Units audited against RCoA and OAA standards
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OAA Epidural Information Card offered as part of consent
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24/7 anaesthetic cover for review of post-procedure headache or neurology
Safety, risks and contraindications
What can happen — and how likely it is.
Epidural is contraindicated if you refuse it, if you have a coagulopathy or are on certain anticoagulants, if there is infection at the puncture site, raised intracranial pressure, or some structural spinal disease. Everything else is a discussion.
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Patchy or failed block (5–15%)
A small proportion of epidurals do not cover the pain evenly. The catheter can be re-sited, or an alternative technique used.
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Hypotension
A drop in blood pressure is common and expected — treated with a fluid load and a small dose of vasopressor.
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Inadvertent dural puncture (~1%)
The needle can occasionally puncture the dura, causing a distinctive positional headache. An epidural blood patch usually settles it.
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Meningitis (<1:100,000)
Aseptic technique makes infection rare, but new fever, neck stiffness or severe headache after an epidural is always reviewed urgently.
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Epidural haematoma (<1:200,000)
Rare but serious — higher on anticoagulants. Sudden weakness or numbness needs urgent MRI and, if confirmed, neurosurgical decompression within hours.
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Permanent nerve injury (RCoA NAP3)
The UK NAP3 audit put permanent injury at roughly 1 in 24,000 to 1 in 54,000 epidurals — very rare, honestly quoted.
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Transient nerve root pain
A brief electric shock down the leg during insertion happens occasionally and usually settles without treatment.
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Urinary retention and itch
Common short-term effects — a catheter is often used during labour, and itch from opioids settles within hours.
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Second-stage of labour may prolong 15–20 min
Good UK evidence does not show more caesareans with epidural, but the pushing stage can run a little longer.
Reading your anaesthetic note
Your anaesthetic note in four parts. Read the last one first.
Whatever the indication, the note the anaesthetist writes keeps to the same shape.
A quiet reminder
Anaesthetic notes are precise and can read technically — we translate them for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and consent
Whether the epidural was placed for labour analgesia, conversion to LSCS, or peri-operative pain control — and the consent process used (usually the OAA card).
- 02 Technique
Level, needle, catheter, drugs
Vertebral level (e.g. L3/4 or T8/9), needle used, depth to loss-of-resistance, catheter length in the space, and the drug regime.
- 03 Findings
Complications and block quality
Any dural puncture, blood in the catheter, patchy block, hypotension, or need for re-siting — with the response noted.
- 04 Impression
Post-op plan and neurological check
Read this first: when the catheter is removed, what to watch for (new back pain, weakness, headache), and who to call.
Recognised by major UK insurers
Anaesthetic fees for epidural in labour or peri-operative use are usually covered as part of the wider maternity or surgical package. We confirm cover before booking.
Frequently asked
Everything we get asked about epidural anaesthetic.
Quick answers on how it feels, how it compares with a spinal, what the real risks are, and what to watch for afterwards.
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What is an epidural anaesthetic?
A fine catheter is placed into the epidural space of the spine, usually in the lower back for labour or in the mid-back for major surgery. Local anaesthetic and a small dose of opioid are given through it to block pain signals from a defined level downwards.
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Is an epidural safe in labour?
Yes. In UK maternity units it is the gold-standard labour analgesia and is used in roughly one in three labours. Good evidence shows it does not increase caesarean rates, though the pushing stage may run 15–20 minutes longer.
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Does an epidural hurt to have put in?
The area is numbed with local anaesthetic first, so the epidural needle itself feels like firm pressure rather than sharp pain. The whole insertion usually takes 15–20 minutes.
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What is the difference between an epidural and a spinal?
A spinal is a single injection into the fluid around the spinal cord — fast onset, wears off in a few hours. An epidural is a catheter left in the space just outside the dura — slower onset, but can be topped up for hours or days.
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What are the serious risks of an epidural?
The commonest specific risk is a post-dural-puncture headache (about 1%). Meningitis is very rare (<1:100,000). Epidural haematoma requiring urgent decompression is rarer still (<1:200,000). The RCoA NAP3 audit put permanent nerve injury at roughly 1 in 24,000 to 1 in 54,000.
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Will an epidural slow my labour or lead to a caesarean?
Modern low-dose "mobile" epidurals do not increase the caesarean rate. They may prolong the second (pushing) stage by 15–20 minutes and slightly increase the chance of an instrumental delivery.
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How long can a peri-operative epidural stay in?
Usually two to four days after major abdominal, thoracic or vascular surgery, as part of an enhanced recovery (ERAS) pathway. The catheter is removed once you are managing on tablet painkillers.
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What is the OAA Epidural Information Card?
A standard UK consent aid produced by the Obstetric Anaesthetists’ Association. It sets out the benefits, common side effects and rare serious risks of a labour epidural in plain language, and is offered before consent is taken.
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What should I watch for after the catheter comes out?
New severe headache (especially worse sitting up), new back pain, leg weakness, numbness in the bottom or difficulty passing urine — any of these should be reported to the anaesthetic team the same day.