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Spinal and epidural anesthesia

Definition

Spinal and epidural anesthesia are medicines that numb parts of your body to block pain. They are given through shots in or around the spine. You will stay awake during both of these types of anesthesia.

Alternative Names

Intraspinal anesthesia; Subarachnoid anesthesia; Epidural; Epidural block; Peridural anesthesia

Description

The area of your back where the needle will be inserted will be cleaned with a special solution. Most of the time this shot will go in your lower back. This area may also be numbed with a local anesthetic. You may receive fluids through an intravenous line (IV, in a vein). You may also receive medicine to help you relax.

For an epidural:

• The doctor will inject medicine just outside of the sac of fluid around your spinal cord. This called the epidural space.
• The medicine numbs, or “blocks” feeling in a certain part of your body so that you cannot feel pain. The medicine begins to take effect in about 10 to 20 minutes. It works well for longer procedures. Women often have epidurals during childbirth.
• A small catheter (tube) is often left in place. You can receive more medicine through the catheter to help control your pain during or after your procedure.

For a spinal:

• The anesthesiologist will inject medicine into the fluid in your spinal cord. This is usually done only once, so you will not need to have a catheter placed.
• The medicine begins to take effect right away. It works well for shorter and simpler procedures.

Oxygen levels in your blood, your pulse, and your blood pressure will be checked during your procedure. You will have a bandage where the needle was inserted.

Why the Procedure Is Performed

Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). Patients usually recover much faster and can go home sooner.

Spinal anesthesia is often used for genital, urologic, or lower body procedures.

Epidural anesthesia is often used during labor and delivery and surgery in the pelvis and legs.

Epidural and spinal anesthesia are often used when:

• The procedure or labor is too painful without any pain medicine.
• The procedure is in the belly, chest, legs, or feet.
• Your body can remain in a comfortable position during your procedure.
• You want fewer side effects and shorter recovery than you would have from general anesthesia.

Risks

Spinal and epidural anesthesia are generally safe. Ask your doctor about these complications.

• Severe headache
• Drop in blood pressure
• Nerve damage
• Infection in your spine (meningitis or abscess)
• Allergic reaction to the anesthesia used
• Difficulty urinating
• Bleeding around the spinal column (hematoma)
• Seizures (this is rare)

Before the Procedure

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

During the days before the procedure:

• Tell your doctor about any allergies or health conditions you have, what medicines you are taking, and what anesthesia or sedation you have had before.
• If your procedure is planned, you may be asked to stop taking any drugs that make it hard for your blood to clot several days before. Some of these are aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), naproxen (Aleve, Naprosyn), and heparin.
• Ask your doctor which drugs you should still take the day of your procedure.
• Arrange for a responsible adult to drive you to and from the hospital or clinic.
• If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of the procedure:

• You will usually be asked not to drink or eat anything after midnight the night before the surgery.
• Do not drink alcohol the night before and the day of your procedure.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital or clinic.

After the Procedure

After an epidural, the catheter will be removed, and you will lie in bed until you have feeling in your legs and can walk. You may feel sick to your stomach and be dizzy. You may be tired.

After spinal anesthesia, you will lay flat in bed for a few hours to keep from getting a headache. You may feel sick to your stomach and be dizzy. You may be tired.

Outlook (Prognosis)

Most patients feel no pain during spinal and epidural anesthesia and recover fully.

References

Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 18.

Hawkins JL, Arens JF, Bucklin BA, et al. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology. April 2007;106(4).

Gerges FJ, Kanazi GE, Jabbour-khoury SI. Anesthesia for laparoscopy: a review. Journal of Clinical Anesthesia. Feb 2006;18(1).

Reynolds F. Neurological Infections After Neuraxial Anesthesia. Anesthesiology Clinics. March 2008;26(1).

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