Spinal Anaesthesia

Having a spinal anaesthetic for your Caesarean Section

For many operations, patients receive a general anaesthetic and remain anaesthetised during the operation. A spinal anaesthetic (‘a spinal’) may be used instead for some operations like Caesarean Section. Depending on the type of operation and your own medical condition, a spinal anaesthetic may sometimes be safer for you and suit you better than a general anaesthetic.

You can normally choose:

  • To remain fully conscious
  • To have some mild sedation during your operation. This makes you relaxed and drowsy although you remain conscious
  • Or occasionally a spinal anaesthetic may be combined with a general anaesthetic. Almost any operation performed below the waistline is suitable for a spinal and there are benefits to both you and your surgeon when a spinal is used.

What is a spinal?

A local anaesthetic drug is injected through a needle into the small of your back to numb the nerves from the waist down to the toes for two to three hours.

How is the spinal performed?

  1. Your anaesthetist will discuss the procedure with you beforehand.
  2. A needle will be used to insert a thin plastic tube (a ‘cannula’) into a vein in your hand or arm and then the staff looking after you will help you into the correct position for the spinal.
  3. You will either sit on the side of the bed with your feet on a low stool or lie on your side, curled up with your knees tucked up towards your chest. In either case, the staff will support and reassure you during the injection.
  4. The anaesthetist will explain what is happening throughout the process so that you are aware of what is taking place ‘behind your back’.
  5. As the spinal begins to take effect, your anaesthetist will measure its progress and test its effectiveness.
  6. Your anaesthetist will give you the spinal injection and stay with you throughout the procedure.

What will I feel?

Usually, a spinal should cause you no unpleasant feelings and should take only a few minutes to perform.

As the injection is made you may feel pins and needles or a sharp tingle in one of your legs – if you do, try to remain still, and tell your anaesthetist about it.

When the injection is finished you normally lie flat as the spinal works quickly and is usually effective within 5 -10 minutes.

To start with the skin feels numb to touch and the leg muscles are weak.

When the injection is working fully you will be unable to move your legs or feel any pain below the waist.

During the operation you may be given oxygen to breathe via a lightweight, clear plastic mask to improve oxygen levels in your blood.

Only when both you and the anaesthetist are completely happy that the anaesthetic has taken effect will you be prepared for the operation.

Why have a spinal?

Advantages, there may be:

  • Reduced blood loss during surgery/less need for blood transfusion
  • You can be awake and communicate with your husband throughout surgery
  • You can see your baby being delivered
  • You can breast feed your baby while surgery is still on, promoting better bonding and helping uterus contract.
  • Less risk of blood clots forming in the leg veins (deep vein thrombosis, DVT).
  • Less risk of chest infections after surgery.
  • Less effect on the heart and lungs.
  • Excellent pain relief immediately after surgery.
  • Less need for strong pain relieving drugs.
  • Less sickness and vomiting.
  • Earlier return to drinking and eating after surgery.

With a spinal, you can communicate with the anaesthetist and surgeon before, during and after surgery. If an operating camera is being used, you may even be able to watch the operation on television if you wish! Alternatively, you may decide that you wish to have sedation while the operation is in progress.

However, you may still need a general anaesthetic if:

  • Your anaesthetist cannot perform the spinal satisfactorily
  • The spinal does not work satisfactorily
  • The surgery is more complicated than expected.

Side effects and complications

As with all anaesthetic techniques there is a possibility of unwanted side effects or complications.

Very common and common side effects

These may be unpleasant, but are easily treated and do not last long.

  • Headache – When the spinal wears off and you begin to move around there is a risk of developing a headache. This risk is practically negligible with the new needles which are finer than hair.
  • Low blood pressure – As the spinal takes effect, it can lower your blood pressure and make you feel faint or sick. This can be controlled with the fluids given by the drip and by giving you drugs to raise your blood pressure.
  • Itching – This can occur as a side effect of using morphine-like drugs in combination with local anaesthetic drugs in spinal anaesthesia. If you experience itching it can be treated, as long as you tell the staff when it occurs.
  • Difficulty passing water (urinary retention) – You may find it difficult to empty your bladder normally for as long as the spinal lasts. Your bladder function returns to normal after the spinal wears off. You may require a catheter to be placed in your bladder temporarily, either while the spinal wears off or as part of the surgical procedure.
  • Pain during the injection – As previously mentioned, you should immediately tell your anaesthetist if you feel any pain or pins and needles in your legs or bottom as this may indicate irritation or damage to a nerve and the needle will need to be repositioned.

After your spinal

Your nurses will make sure that the numb area is protected from pressure and injury until sensation returns.

It takes 1.5 to four hours for feeling (sensation) to return to the area of your body that is numb. You should tell the ward staff about any concerns or worries you may have.

As sensation returns you may experience some tingling in the skin as the spinal wears off. At this point you may become aware of some pain from the operation site and you should ask for more pain relief before the pain becomes too obvious.

As the spinal anaesthetic wears off, please ask for help when you first get out of bed, which is usually after 24 hours.

You can normally drink fluids within 6 hours of the operation and may also be able to eat a light diet by 24 hours.

Frequently asked questions

Q Can I eat and drink before my spinal?

You will need to have an empty stomach before your operation and you must follow the same rules as if you were going to have a general anaesthetic. This is because it is occasionally necessary to change from a spinal anaesthetic to a general anaesthetic.

Q Must I stay fully conscious?

Before the operation you and your anaesthetist can decide together whether you remain fully awake during the operation or would prefer to be lightly sedated so that you are not so aware of the whole process. The amount of sedation can be adjusted so that you are aware but not anxious. It is also possible to combine a spinal with a light general anaesthetic.

Will I see what is happening to me?

Sometimes you can choose. Normally a screen is placed across your upper chest so that you see nothing when surgery starts. You will be aware of the ‘hustle and bustle’ of the operating theatre when you come in. Once surgery starts noise levels drop. You will be able to relax, with your nurse and your anaesthetist looking after you. Some patients like to wear personal stereo headphones to listen to their own choice of music during the operation. There is a stereo player available in the Operation Theatre which usually plays FM radio but you can always choose to burn a CD and bring along. The options available to you will vary, depending on a number of factors to do with your operation.

Q Do I have a choice of anaesthetic?

Yes. Your anaesthetist will assess your overall preferences and needs for the surgery and discuss them with you. If you have anxieties regarding the spinal then these should be answered during your discussions, as it is usually possible to accommodate individual patients’ wishes and still use a spinal anaesthetic.

Q Can I refuse to have the spinal?

Yes. If, following discussion with your anaesthetist, you are still unhappy about having a spinal anaesthetic you can always say no. You will never be forced to have any anaesthetic procedure that you don’t want.

Q Will I feel anything during the operation?

Your anaesthetist will not permit surgery to begin until you are both convinced that the spinal is working properly. You will be tested several times to make sure of this. You should not feel any pain during the operation but you may well be aware of other sensations such as movement or pressure as the surgical team carry out their work.

Q Should I tell the anaesthetist anything during the operation?

Yes, your anaesthetist will want to know about any sensations or other feelings you experience during the operation. They will make adjustments to your care throughout the operation and be able to explain things to you.

Q Is a spinal the same as an epidural?

No, although they both involve an injection of local anaesthetic between the bones of the spine in the small of your back, the injections work in a slightly different way and should not be confused.

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Rajeev Agarwal

<p><strong><span style="font-size: 12px; "><span style="font-family: Arial; ">&nbsp;One of the things that I am ALWAYS asked by patients and family is that they have heard that Spinal Anaesthesia leaves behind a backache. Despite all reassurances that backache has nothing to do with Spinal, that it can happen for variety of reasons, that even people who have never taken a spinal still may have backache, some are still not convinced.</span></span></strong></p> <p><strong><span style="font-size: 12px; "><span style="font-family: Arial; ">Thus i decided to copy a chapter from one of the most distinguished books on Anaesthesia. Here is an excerpt. It may sound too tehnical for a lot of people, but thats the language we doctors speak amongst ourselves, for whom the book is written :)</span></span></strong></p> <p> <p class="MsoNormal"><strong><span style="font-size: 12px; "><span style="font-family: Arial; "><span lang="EN-US" style="line-height: 115%; ">On a short term basis, posterior pelvic soreness with backache is a very common complaint, which may be experienced in upto 70 % of women during pregnancy and after childbirth. Various factors that occur during pregnancy, such as multiple pregnancy and preexisting or severe back pain, are strongly associated with the intensity and persistence of pain for months after delivery. Regional anesthesia should not be implicated as the cause of backache or other symptoms after delivery; instead a detailed clinical and radiologic investigation and eventually prompt surgical treatment are recommended. A magnetic resonance imaging (MRI) investigation in London revealed lumbar disc abnormalities in 9 to 35 women studied postpartum. The soft tissue changes were found in the lumbar region in all women, and in 12 (34%) of them the changes were rated as severe, with an average of five segments involved. These changes were reversible and unrelated either to the mode of delivery, the use of epidural block, or the trauma of epidural cannulation. Symphysis pubis separation, with or without involvement of sacroiliac joints, is considered a rare complication, with an incidence of 1 case of 30,000 upto 1 case in 500 to 600 deliveries. The episode of severe pain occurred during labor despite adequate epidural block, or epidural analgesia was used for the treatment and mobility antepartum in symphysis pubis separation.</span></span></span></strong><b><span lang="EN-US" style="font-size:12.0pt;line-height:115%;font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><o:p></o:p></span></b></p> <p class="MsoNormal"><strong><span style="font-size: 12px; "><span style="font-family: Arial; "><span lang="EN-US" style="line-height: 115%; ">A controversy started in the early 1990s when several retrospective inquiries concluded that epidural anesthesia for labor (but not for cesarean delivery) was associated with (1) a backache for months to years after delivery (2) a new long term backache (although it tends to be postural and not severe) 12 to 15 months after child birth or a new back pain 1 year after delivery. The risk of low back pain was significantly increased on the first day after epidural delivery, but otherwise the association between epidural block and postpartum low back pain was found to be inconsistent. The subsequent properly designed and prospective studies evaluated all factors associated with the back pain and cleared the controversy. Breen and coworkers interviewed more than 1000 women an found that the incidence (44%) of back pain 1 and 2 months after delivery was identical in women who delivered with or without epidural analgesia. The predisposing factors for new onset of back pain were greater weight and shorter stature. Russell and coworkers and Macarthur and coworkers came to similar conclusions; namely that epidural block for labor and delivery per se does not increase the incidence of back pain 3 and 12 months after delivery. The factors associated with backache 3 months after delivery was the history of backache before and during pregnancy. A prospective study of epidural and combined spinal epidural anesthesia for elective cesarean delivery documented back pain in over half of the women (55% versus 62 % respectively) during the first 3 postpartum days. In 5 of 114 patients, a new backache occurred but it was unrelated to the epidural site. A prospective study of 270 women after epidural anesthesia for labor found that the incidence of backache after delivery (31%) decreased (9%) 14 days later. The history of back pain was confirmed to increase the likelihood of any back pain after delivery. Thus, the regional anesthesia techniques in obstetrics do not increase the risk of postpartum low back pain.&nbsp;</span></span></span></strong><b><span lang="EN-US" style="font-size:12.0pt;line-height:115%;font-family:&quot;Arial&quot;,&quot;sans-serif&quot;"><u><o:p></o:p></u></span></b></p> </p>