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Spinal & Epidural Anesthesia
Please note that the following guidelines apply to most patients having surgery, but not all of the patients. These are general guidelines only. Specific conditions may require specific needs. Please contact the pre-op nurse or anesthesiologist if you have any questions.
Spinal anesthesia is placed in the low back (lumbar region). After a sterile prep and draping, local anesthetic is placed in the skin to numb the area where the Spinal needle will be placed. The Spinal needle passes between the vertebrae of the Spinal column through the dural membrane where the cerebroSpinal fluid is located. Once the placement of the needle is accomplished medicines including a local anesthetic and sometimes a narcotic are dispensed via the needle. The needle is then removed. The entire process usually takes anywhere from 5- 20 minutes.
Epidural anesthesia is most commonly placed in the low back(lumbar region). Unlike Spinal this technique may also be accomplished in the mid-back(thoracic region) for surgery in the area of the chest. After a sterile prep and draping, local anesthetic is placed in the skin numb the area where the Epidural need will be placed. The needle for Epidural passes between the vertebrae of the Spinal column to the Epidural space. Once the position is verified, a very small catheter(tube) is placed via the needle. The needle is then removed and the catheter remains in the Epidural space. The catheter is then taped to the patients back. Local anesthetics and narcotics given epidurally via this catheter. The procedure usually takes 10 - 25 minutes.
Who administers the Spinal or Epidural anesthetic ?
A anesthesiologist is a physician who specializes in the treatment of pain and the methods used to make a patient unable to sense the pain associated with surgery. Anesthesiologists are fully trained physicians who have completed medical school plus an internship and 3 years of training in anesthesia. All of the anesthesiologists at Redding Medical Center are Board Certified or Board eligible by the American Board of Anesthesiology.
What is it like to have a Spinal or Epidural ? Is it painful ?
In order to place the Spinal or Epidural the must have a IV placed. The patient is placed on various monitors(pulse oximeter, BP, EKG). The patients are then positioned in either the sitting or lateral position. Once the local anesthetic is place in the skin there should be a pressure sensation when the Spinal or Epidural needles are placed. As these needles are being placed sometimes a patient may feel a strong tingling in the area of the hip or shooting down the leg. This is usually only a transient sensation and should not alarm the patient. The anesthesiologist should be informed of this. It is important for the patient to hold still during the procedure as this greatly assists the physician in placement. Once the anesthetic has been placed the patient will begin to feel warming of the bottom and legs followed by loss of sensation of the involved area. This is followed by a loss of strength. The time period is anywhere from 5-25 minutes.
Will I have to stay flat for many hours after a Spinal ?
No. Not usually. With the use of smaller, sharper and disposable needles, you do not have to stay flat. You do need to stay in the bed until you recover fully from the effects of Spinal anesthesia. i.e. You have got the full strength back.
Postdural puncture headache occurs infrequently with these techniques. The risk seems to be higher with younger age and larger size of the needle. The risks is about 1% with Epidurals and 3% with Spinals. This is believed to be due to a leak of cerebroSpinal fluid from the needle hole in the dura. The occurrence of this is greatly reduced by using a smaller needle when possible. If this headache does occur it may be treated initially with hydration and pain medicines. If the headache does not resolve it would be treated with an Epidural blood patch. This if essentially using the patients own blood to block the leak via the Epidural technique.
Is there a risk of being paralyzed or permanent damage ?
The risks of paralysis is extremely low. The actual incidence of neurologic dysfunction resulting from bleeding complications is estimated to be 1 in 150,000 for Epidurals and 1 in 220,000 for Spinal anesthetics.
What are the risks of Spinal and Epidural anesthesia ?
The risks for Spinal and Epidural anesthesia may include low blood pressure. Which is the reason the patient is routinely hydrated prior to the placement of either of these forms of anesthesia. Some of the time it is necessary to treat it with medication this is regularly by the anesthesiologist.
Postdural puncture headache occurs infrequently with these techniques. The risks is 1% with Epidurals and 3% with Spinals. This is believed to be due to a leak of cerebroSpinal fluid from the needle hole in the dura. The occurrence of this is greatly reduced by using a smaller needle when possible. If this headache does occur it may be treated initially with hydration and pain medicines. If the headache does not resolve it would be treated with an Epidural blood patch. This if essentially using the patients own blood to block the leak via the Epidural technique.
Backache is an infrequent problem. It most likely is due to ligament strain due to profound muscle relaxation or surgical positioning.
Other complications that can occur include, but are not limited to, infection, nerve damage(including paralysis, loss of bladder and bowel function, loss of sexual function), allergic reactions, seizures, cardiac arrest and death. Although the result of these are severe they occur very rarely.
Will I be awake during the surgery ?
The patient will usually be sedated via intravenous medications during the surgery and many times before placement of the Spinal or Epidural. It is possible to sedate the patient so that they will be comfortable and without anxiety during the surgical procedure.. It is the understanding of the anesthesiologist that most patients do not want to know what is going on why surgery is being carried out. In fact, a lot of patients even may not remember receiving a Spinal or Epidural anesthetic.
Is Spinal or Epidural used along with general anesthesia ?
In surgery on the blood vessels, the chest and for post-operative pain control Spinal or Epidural may be used along with general anesthesia. There are some great benefits from these techniques which include decreased blood loss during surgery, decreased risks of phlebitis, and a reduced risks of stress reaction as a direct result of the patient having surgery.
In the case of Spinal, when narcotics are added, this can give a patient anywhere from 12 - 24 hours pain relief after surgery. Epidural is much longer pain control because a small catheter is placed in the back and this may be used for 1 to 4 days post operatively.
Some of the side effects of the narcotics that the patient would receive via these techniques include itching, nausea, vomiting, and/or diminished respiratory rate. Other medications may be administered to relieve these symptoms.
When is a patient not a candidate for a Spinal or Epidural ?
The patient may not be a candidate for these techniques if one is 1) allergic to certain local anesthetics or narcotics, 2) have disease of the nervous system, 3) have a bleeding tendency or coagulation disorder, 4) have an infection of the lower back area, 5) have had previous lower back surgery, 6) have a Spinal deformity, 7) are morbidly obese (very overweight), 8) cannot cooperate or get into the proper position.
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Last modified: May 14, 2003
May 16, 1998