Is it necessary to lie supine after epidural anesthesia?

After an epidural anesthesia of a pregnant woman is returned to the ward, the doctor often asks her to lie supine on the pillow for 6 hours. Is this necessary? In order to let everyone understand this, let’s analyze it below. 　　 Postoperative headache is a common complications of spinal anesthesia In order to avoid possible headaches, go to sleep supine for 6 hours after surgery.　　 Epidural anesthesia is a method in which drugs are injected into the epidural space to produce an anesthetic effect. Because the spinal dura reaches the foramen magnum and fusion of the periosteum on the foramen magnum, that is, the epidural space is closed at the foramen magnum and does not communicate directly with the skull. After our conventional anesthetics are injected into the epidural space, it is impossible to directly enter the subarachnoid space, without affecting the volume and pressure of cerebrospinal fluid. Anatomically and physiologically, complications such as headache and head swelling will not occur after epidural anesthesia.　　 But some people may be worried that the blood pressure of patients after epidural anesthesia will be lowered, and they are afraid that sleeping on a pillow will affect blood pressure. In fact, the basis for this worry is insufficient. Spinal epidural anesthesia, especially some high-level epidural anesthesia, can paralyze visceral nerves, dilate blood vessels in the abdominal cavity, blood stasis, and fluctuate blood pressure. If the blood volume is insufficient, the acid-base balance is disturbed or the heart function is poor, the cardiac output will decrease, and the blood pressure will drop more obviously. These changes basically returned to normal or were already in the compensatory stage when returning to the ward. At this time, whether to remove the pillow or not will not affect the changes in blood pressure and pulse. But if there is hypovolemia and other causes of hypotension, it can occur regardless of whether the pillow is removed.　　 In fact, proper lying position after surgery is not only beneficial to treatment, but also can reduce the symptoms of some patients. Sleeping supine on the pillow is a comfortable lying position that most people are accustomed to. If there are no other special requirements, pillows can be given after surgery. This can not only reduce the patient's fear of the disease, but also eliminate the nervousness and worry of the family members.　　 whether to remove the pillow or not, there was no significant difference in the effects of postoperative epidural anesthesia on blood pressure, respiration, pulse, and postoperative headache and dizziness.　　 Clinically, we may encounter some other situations: such as the need for epidural anesthesia combined with intravenous sedation, analgesic enhancement, etc. At the end of this type of operation, although the patient is conscious, he may be in a state of lethargy, indicating that there is still a certain amount of intravenous medicine remaining. At this time, we recommend going to the pillow to lie supine to ensure good ventilation, and oxygen if necessary; for example, due to intraoperative drugs, some special surgical treatments, surgical sites, etc., the patient has nausea and vomiting after returning to the ward . At this time, we also recommend that the patient lie supine on the pillow, and try to position the head side as much as possible when vomiting to facilitate the outflow of vomit and prevent aspiration. In the end, let’s summarize that in terms of epidural anesthesia surgery alone, if the patient returns to the ward after the operation in a stable condition, there is no need to lie supine on the pillow.　　 However, if the spinal dura is penetrated during epidural anesthesia, you must go to the pillow and lie supine, and it is best to stick to it for 1-2 days, and try to make up fluids. For details, please consult an anesthesiologist. If the patient has drowsiness, nausea and vomiting, it is recommended to go to supine on the pillow.

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