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Item ID: MON262   Source ID: 2

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by Patricia Griffin Kellicker, BSN

Anatomy and Physiology
Spinal and epidural anesthesia are used during surgery to block sensation to the lower half of the body. With this type of regional anesthesia, numbing medications are injected directly into the spinal area.

The spine is made up of small bones called vertebrae, soft disks between the vertebrae that act as cushions, and ligaments holding the vertebrae in place. Housed within the vertebrae is the spinal cord with its many projecting spinal nerves. The spinal cord and nerves are located in a sac of fluid surrounded by a protective covering called the dura layer.

Reasons for Procedure
Spinal or epidural anesthesia may be recommended because of the type of surgery you are having, or to avoid the risks of general anesthesia. Some studies suggest that regional anesthesia results in less blood loss and better pain control after surgery.

Spinal and epidural anesthesia are most commonly used for surgeries involving the pelvis, hips, and legs. They are also commonly used during childbirth.

Treatments
In spinal anesthesia, medications are injected directly into the sac of fluid surrounding the spinal cord and nerves. In epidural anesthesia, the medications are injected in the space next to the dura layer.

The medications that block pain may cause your legs to become numb. You may be unable to move your legs until the anesthesia wears off. Since the nerves to your bladder may also be affected, you may have to have a catheter inserted into your bladder depending on the length of your surgery.

Procedure
Prior to your surgery, an anesthesiologist will ask you questions to help determine the best anesthesia plan for you. You will be asked about: medications you are taking, medical conditions like heart and lung conditions, food or medication allergies, previous experience with anesthesia, any reactions you or other family members have had to anesthesia, smoking or alcohol habits.

Before surgery an intravenous line will be placed in your arm to deliver medications and fluid. You may be given medications to relax you, make you sleepy, or to treat any changes in your blood pressure.

You will be attached to various monitors that track your blood pressure, pulse, and the oxygen content in your blood. Your blood pressure will be closely monitored because this type of anesthesia can cause low blood pressure.

Next you will be positioned so that your back can be swabbed with a disinfectant solution, and you may receive an injection of local anesthesia to numb the site where the spinal or epidural anesthesia is given.

If given spinal anesthesia, you will receive a single injection of medication into the sac of fluid that surrounds your spinal cord. This type of anesthesia begins working almost immediately.

If given epidural anesthesia, you will receive an injection of medication outside the sac of fluid that surrounds your spinal cord, next to the dura layer. This type of anesthesia begins working in about 10 minutes.

When more than one dose of epidural anesthesia is required, a small flexible tube, or catheter will be left in place. In case there is a need for additional pain control after the procedure, the catheter can remain in place to give more anesthesia or pain medication.

The needle insertion for either spinal or epidural anesthesia may be painful. If at any point you feel pain in the legs, let your doctor know. It may mean that the needle is close to a nerve.

Risks and Benefits
Possible complications of spinal and epidural anesthesia include: severe headache, drop in blood pressure, nerve damage, internal bleeding, infection, blood clots in the legs that could travel to the lungs, allergic reaction to anesthetic used, stroke, and/or heart attack.

Benefits of spinal and epidural anesthesia include: the ability to stay awake during the procedure, possibly less blood loss and better pain control after surgery, avoiding the complications of general anesthesia.

When considering anesthesia, or any medical procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate choice for you.

After the Procedure
Once the procedure is complete, a small bandage will be placed over the site where the needle was inserted. If you had an epidural, the catheter may be withdrawn after surgery, or left in place to deliver more medication.

If you had spinal anesthesia, you will asked to lie flat for a number of hours to prevent a headache. For both types of anesthesia, you will be kept in bed until feeling returns to your legs and it is safe to walk. You will be advised to avoid driving, operating machinery or drinking alcohol for at least 24 hours after receiving anesthesia.

Once you are home, contact your doctor immediately if you experience any of the following: fever, persistent or severe headache, dizziness, fainting, weakness, numbness, or tingling in arms or legs, skin rash, difficulty breathing, shortness of breath, and/or swelling in the legs.

Sources:

  • American Society of Anesthesiologists. Anesthesia and You. Available at: http://www.asahq.org/patientEducation/anesandyou.htm. Accessed June 22, 2004.
  • U.S. National Library of Medicine and the National Institutes of Health. Epidural Anesthesia. Available at: http://www.nlm.nih.gov/medlineplus/tutorials/epiduralanesthesia.html. Accessed June 21, 2004.
  • Mayoclinic.com. Anesthesia:Options and considerations. Available at: http://www.mayoclinic.com. Accessed June 22, 2004.


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