Spinal and Epidural Anesthesia

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What is Spinal Anesthesia?

Spinal anesthesia is a form of regional anesthesia that involves the injection of certain anesthetic drugs in the region adjacent to the spinal cord or just outside it using a fine long needle. This renders the portion of the body beyond / below (as the case maybe) the point of injection numb and anesthetized, while the rest of the body remains active.

The injection is usually administered in a space called the subarachnoid in the lumbar (low back) spine. This form of anesthesia is easy to administer and is ideally suited for surgeries performed in the lower parts of the body.

What are the Indications for Spinal Anesthesia?

  • Surgeries below the level of the umbilicus; examples are genitourinary surgery, gynecological surgery, hernial repair procedures, and surgeries performed on the lower extremities.
  • It is especially suited for older patients and those with diseases such as chronic respiratory/renal/hepatic disease.
  • Diabetics also face an advantage from spinal anesthesia.
  • It is also suitable in cases of trauma where there is a need for emergency surgery.
Indications for Spinal Anesthesia

How do you Perform Spinal Anesthesia?

The patient is usually positioned in a sitting posture on the operating table. A small stool can be given for the patient’s convenience or support. The forearms can be made to rest on the thighs to make the patient stable and comfortable.

Alternatively, the procedure can also be performed with the patient lying on their side with their hips and knees maximally flexed in the form of the letter C.

Following positioning, the anesthetist will clean your back using an anti-septic solution. He may administer a little bit of local anesthetic to numb the skin at the point where he is going to give the spinal, so that you do not feel the pain due to the spinal needle. The anesthetic solution is then injected into the spinal space usually between the lumbar vertebrae L3 and L4 through a long needle. This is subject to change and can vary from one individual to another. After successful administration, you will be positioned in the required position and once again all your parameters will be checked by the anesthetist.

Spinal & Epidural Anesthesia Position

What are the Advantages of Spinal Anesthesia?

  • Relatively cheap
  • Patient satisfaction
  • Reduced risk of respiratory complications
  • Superior muscle relaxation
  • Less bleeding
  • Quick restoration of bowel function
  • Reduced incidence of coagulation disorders following surgery
  • Reduced post operative stay

What are the Disadvantages of Spinal Anesthesia?

The time required for anesthetic induction varies depending on the anesthetist's skill and competence.

In some cases, it might be difficult to locate the dural space and obtain cerebrospinal fluid. The procedure has to be avoided in such situations.

It is generally not advisable to employ spinal anesthesia for surgeries lasting for more than 2 hours.

Potential risk of hypotension due to overload and meningitis due to improperly sterilized medical equipment.

Spinal anesthesia may not be suited for a certain group of patients even if they are sedated. This is because different people react or respond in different ways to anesthesia.

What are the Contraindications to Spinal Anesthesia?

  • Spinal anesthesia should not be attempted when there is a lack of availability of proper or necessary equipment for the same.
  • Special consideration should be given to patients with abnormal bleeding and clotting parameters, or liver disease. Furthermore, patients receiving anticoagulants such as warfarin or heparin are at increased risk.
  • Patients with severe fluid loss either by bleeding, vomiting, or diarrhea should be replaced with adequate fluids before being taken up for spinal anesthesia due to the risk of hypotension.
  • Patient’s refusal for the administration either due to lack of knowledge or preference for general anesthesia. It might be possible to convince some patients if the situation is properly explained.
  • Uncooperative patients such as children, mentally challenged individuals, or patients with psychiatric disorders.
  • Anatomical difficulties that might make the administration of anesthesia difficult.
  • Presence of neurological disease, or infection of skin around the lumbar area in the back.

What is Epidural Anesthesia?

This form of administration had many applications and was first used in humans in the year 1921. It is very versatile as it can be used as an anesthetic in combination with general anesthesia, and to reduce the post-operative pain following surgery of the lower limbs, perineum, pelvis, abdomen and thorax.

Epidural anesthesia is used as anesthetic for procedures involving the lower limbs, pelvis, perineum and lower abdomen. It is also possible to perform upper abdominal and thoracic procedures under epidural anesthesia alone.

What are the Indications for Epidural Anesthesia?

  • Hip and Knee surgery
  • Surgery in the lower limb, or amputation
  • Obstetrics: Difficult or high-risk labor, twin pregnancy, pre-eclampsia, and prolonged labor. Cesarean section performed under epidural anesthesia is associated with a lower maternal mortality owing to anesthetic factors than under general anesthetic
  • Low concentration local anesthetics, opioids, or combinations of both can be given for control of postoperative pain in patients undergoing abdominal and thoracic procedures
  • Trauma related to the respiratory system with associated rib or sternum fractures
Indications for Epidural Anesthesia

How do you Perform Epidural Anesthesia?

In epidural anesthesia, a hollow needle is inserted into the epidural space in the spinal cord and a small flexible catheter is then inserted into the space through the hollow needle and is then taped unto the back with injection port, so that the medicine can be delivered when needed.

The procedure should be taken up only after a consent form is obtained from the patient and when proper equipments are available. Prior to performing the block, all equipment should be checked. An intravenous line is mandatory before epidural administration to manage any emergency situation that may arise. The administration should be done under strict aseptic conditions. Different types of techniques, procedures and drugs are available. The choice of the ideal approach is dependent on the surgical need and the discretion of the anesthetist.

What are the Advantages of Epidural Anesthesia?

Continous or prolonged pain relief can be provided, unlike spinal anesthesia which lasts only for 2-3 hours.

What are the Complications and Side Effects of Epidural Anesthesia?

  • Hypotension
  • Nausea, sensory loss, difficulty in breathing
  • Toxicity manifested by light-headedness, tinnitus, numbness, feeling of anxiety, confusion, tremor, convulsions, coma and cardio-respiratory arrest
  • Total spinal anesthesia is a rare complication manifested by profound hypotension, apnea, unconsciousness and dilated pupils
Complications and Side Effects of Epidural Anesthesia

What are the Contraindications to Epidural Anesthesia?

  • Patient refusal for surgery, uncooperative patients
  • Abnormal bleeding or clotting parameters, anti-coagulant therapy
  • Skin infection at/near injection site
  • Uncorrected fluid loss (hypovolemia)
  • Presence of neurological disorders, cardiovascular disease
  • Anatomical abnormalities of the vertebral column

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mandreak

I had Ureteroscopy for stone and tumor disnosys in the ureta and went thru Epidural anesthesia, after that i am having sever pain in my left thighs and feet, the pain is sever when i tryt to walk or stand on my leg other wise the pain is very less. please let me know if somebody has solution to this. i sthis due to anesthesia complication, iam diabetic too.

i ask for epidural relation to urinary retention and neurodisorder in IDDM patient

I had laser lithotripsy for removal of stone in ureta and went thru Epidural anesthesia ,since then I have low back pain running thru me left thigh,leg and feet.Please let me know wheter it a complication of anesthesia?

mandreak

Hey did you got some solution ot his or what is the cause of this, any idea?

sagarsam

I also had same surgery and m having pain in my back and neck...pls tell us if any1 knws anything??

guest

65 yr male with no medical history underwent k-nailing with double recon screws for #shaft femur with I/T # under spinal block failed to respond to I/V fluids(4 crystalloids+2 colloids and dopamine or Noradr died after 1 hr of surgery with normal ECG findings and normal chest and SpO2

guest

spinal anesthesia with.5%heavy sensorcain 4ml.immediatly after deposition of drug patient had intense itching on buttucks & pernium brncospasm,jerks convulsions cynosis comacontrary to usual finding of hypotention and bradycardia patint after intubation had hypertention150to200systolic and pulse 140 to 170/min. I am not sure for the cause. patient expired after 9hours

pathchi1d

Itching and bronchospasm point towards an allergic cause. jerks convulsions cyanosis point towards improper or delayed airway control. Was after intubation {hypertention150to200systolic and pulse 140 to 170/min }the surge of intubation? Since the patient is dead, we can just prevent others from having the same fate. Drug injection intravenously is unlikely. Spinal anaes. is generally very safe if performed skillfully with the proper precautions by a trained physician with proper guidance and adequate resources at his/her disposal.

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