Spinal Anesthesia

Anesthesia is medicine to make you comfortable during surgery or a procedure. There are many types of anesthesia. Spinal anesthesia is performed when a medication is injected into the fluid surrounding the spinal cord. This deadens the nerves coming out of the spinal cord from the level the needle is inserted on down. In other words, you temporarily will not be able to move your legs or feel them. You may be made numb from your nipples on down. How far up you are numb depends on the type of surgery being done.

Spinal anesthesia begins working almost immediately after the injection of a medication into the spinal canal. Epidural anesthesia takes 10-20 minutes to begin working. The only discomfort from this type of anesthesia is the little stick of the needle into your back to put the medicine into the spinal canal. This is really not much different than having your blood drawn.

REASON FOR RECEIVING SPINAL OR EPIDURAL ANESTHESIA

  • Spinal anesthesia is often used in surgeries of the pelvis, hips, and legs and lower abdomen.

  • Epidural anesthesia is used for pain relief during childbirth and after major abdominal or chest surgery.

ADVANTAGES OF SPINAL AND EPIDURAL ANESTHESIA INCLUDE:

  • The ability to be awake but without discomfort during the operation.

  • To avoid problems of general anesthesia such as:

  • Nausea.

  • Vomiting.

  • Sore throat.

  • Less blood loss during surgery.

  • Better pain control after surgery.

  • Lower incidence of lower extremity blood clots (DVTs) following surgery.

RISK FACTORS THAT MAY CAUSE PROBLEMS

  • If you have a bleeding disorder or are on blood-thinning medicines.

  • If you have had previous bad or allergic reactions to anesthetics.

  • If you have an immune system disorder.

  • If you have a localized infection on your lower back or a systemic infections throughout your body.

LET YOUR CAREGIVER KNOW ABOUT:

  • Your drug allergies.

  • The medications you are taking. Include herbal, vitamin supplements and all over-the-counter medications.

  • Any medical problems you have including heart or lung conditions.

  • Any use of steroids.

  • Any recent alcohol, cigarette or illicit drug use.

  • Any previous reactions that you or other family members have had to anesthesia (especially to local anesthetics).

  • Any bleeding or clotting problems you have had in the past.

RISKS AND COMPLICATIONS

Other than a spinal headache, bad reactions to spinal anesthesia are uncommon. Your caregiver can discuss these with you. Some complications may include:

  • Severe headache.

  • Drop in blood pressure which could lead to heart attack or stroke.

  • Nerve damage (extremely uncommon).

  • Infection.

  • Allergic reaction to the anesthetic used.

  • Seizures.

  • If the anesthesia goes so high it paralyzes your respiratory muscles you may be unable to breathe on your own. If this happens, your caregiver may have to put a tube into your trachea (the main breathing tube into the lungs), and put you on a machine to breathe for you until the anesthetic wears off.

  • You could have long-lasting numbness, pain or loss of function of body parts.

PROCEDURE

  • You will be connected to various monitors to keep track of your blood pressure, pulse, and the amount of oxygen in your blood.

  • Caregivers will either have you lie on your side with your knees and chin bent toward your chest, or may have you sit up on the bed or table. This position opens up the spaces between your back bones and makes it easier for the needle to be placed.

  • Prior to getting spinal or epidural anesthesia, the area of your back where the medicine is injected will be cleaned with a soap-like solution. You may be given an injection of local anesthetic directly over the spot where the spinal or epidural anesthetic will be given, to decrease discomfort from the needle used to give the spinal or epidural anesthetic.

  • A needle is put between the bones of your back. Stay as still and quiet as you can and continue to breathe normally. Tell your anesthesia caregiver if you feel a tingling shock or pain going down a leg, but try not to move.

  • When your caregiver has the needle in the right place, medicine is injected. Spinal anesthesia involves a single injection of medication into the sac of fluid that surrounds your spinal cord.

  • Spinal and epidural anesthesia may cause low blood pressure. An IV (intravenous line) is usually started to give fluids and treat blood pressure problems if they show up during the procedure. You may also be given medications though this line to relax you before the anesthetic is given.

  • Depending on how long the surgery will take, you may have a drainage tube(Foley catheter) put into your bladder to keep your urine drained.

  • Epidural anesthesia may be given as a single injection just outside of the sac of fluid that surrounds your spinal cord. When more than one dose of epidural anesthesia might be required, the anesthetist will leave a tiny, flexible tube or catheter in place outside of the fluid sac surrounding your spinal cord. With this catheter in place, more anesthetic can be given easily if the operation takes longer than expected. Some surgical centers leave the epidural tube in place for 24 hours or more after surgery, using it to give pain medications during the immediate post-surgical period.

  • After the injection of spinal or epidural anesthesia has been completed, or after the epidural catheter has been removed, a small bandage will be placed over the area where the needle was removed.

AFTER THE PROCEDURE

  • After spinal anesthesia, you will be kept in bed for several hours.

  • You will be kept in bed until your legs are no longer numb and it is considered safe for you to walk. This numbness usually wears off in about one to four hours. This depends on the medication and dose used.

  • The length of time you stay in the hospital will depend on the surgery you are having or have had.

  • If you received epidural anesthesia, and you need pain medicine after surgery, the epidural catheter may be left in place in order to continue supplying small doses of numbing anesthesia. The epidural catheter is removed when it is no longer needed.

HOME CARE INSTRUCTIONS

  • Do not drive or operate machinery for at least 24 hours after anesthesia. Make sure someone can drive you home.

  • Do not drink alcohol for at least 24 hours after receiving anesthesia.

  • Do not make important decisions for 24 hours after having spinal or epidural anesthesia. Your thinking may not be clear.

  • Have someone stay with you for at least 24 to 48 hours following surgery.

  • Drink lots of fluids when you get home. If you are an adult, drink eight, 8 ounce glasses of water every day, or as directed.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have a fever or any temperature over 98.6° F (37° C).

  • You have persistent or severe headaches.

  • You have dizziness, fainting or lightheadedness.

  • You have weakness, numbness, or tingling in your arms or legs.

  • You have a skin rash.

  • You have difficulty breathing.

  • You have persistent nausea & vomiting.

  • You are unable to pass urine.