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Spinal and Epidural Anesthesia by Rosalyn Carson-DeWitt, MD

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

These two types of anesthesia numb your body from the chest down to the legs. The medicine is placed directly into the spine area.

Reasons for Procedure

Spinal and epidural anesthesia is frequently given for surgeries involving:

Pelvis, hips, and legs
Childbirth

Advantages of these types of anesthesia include:

Ability to be awake during the operation
Avoid complications of general anesthesia

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have spinal and epidural anesthesia, your doctor will review a list of possible complications, which may include:

Severe headache or back pain
Drop in blood pressure
Nerve damage
Infection
Allergic reaction to the anesthetic used
Longer labor during childbirth (epidural anesthesia)

Some factors that may increase the risk of complications include:

Smoking
Bleeding disorders
Prior allergic reactions to anesthetics
Dehydration
Immune system disorders

Be sure to discuss these risks with your doctor before the surgery.

What to Expect

Prior to Procedure

Make sure that your doctor is aware of:

Your drug allergies
Medicines you are taking
Any heart or lung conditions you have
Any previous reactions that you or other family members have had to anesthesia
Any bleeding problems you have had in the past

Description of the Procedure

You will be connected to various monitors to keep track of your:

Blood pressure
Pulse
Oxygen content of your blood

You may also have:

An IV line to provide you with fluids
A catheter (tube) put into your bladder to keep urine drained

An area on your back above the spinal cord will be cleaned. A local anesthetic will be injected into the skin to numb the area. This is to decrease pain from the larger needle that will be put in your back. If you are getting spinal anesthesia, the doctor will give you one injection. The medicine will be sent directly into the sac of fluid that surrounds the spinal cord.

If you are getting epidural anesthesia, it may be delivered the same way. But, if you need more than one dose, you will have a tiny, flexible tube in place just outside of the fluid sac. This allows the doctor to give you more medicine if you need it. After the surgery, the doctor will place a bandage over the injection spot.

Epidural Injection

Immediately After Procedure

After spinal anesthesia—You may be told to stay in bed with your head flat for several hours. This is to prevent a headache.
After either spinal or epidural anesthesia—You will stay in bed until your legs are no longer numb.

How Long Will It Take?

Giving spinal or epidural anesthesia usually takes about 15 minutes.

Spinal anesthesia—begins working right after the injection is given
Epidural anesthesia—takes about 10-20 minutes to begin working

How Much Will It Hurt?

You will feel some pain when the needle is inserted.

Average Hospital Stay

This depends on the type of surgery being done.

Postoperative Care

At the Hospital

If you received epidural anesthesia, the tube may be left in place to give you more medicine. When you no longer need pain control, the doctor will remove the tube.

At Home

When you return home, do the following to help ensure a smooth recovery:

For the first 24 hours:
- Do not drive or operate machinery.
- Do not drink alcohol.
Be sure to follow your doctor's instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occur:

Signs of infection, including fever and chills
Persistent or severe headache or back pain
Dizziness, fainting
Weakness, numbness, or tingling in your arms or legs
Loss of bladder or bowel control
Skin rash
Difficulty breathing

In case of an emergency, call for medical help right away.

RESOURCES:

American Society of Anesthesiologists http://www.asahq.org
National Library of Medicine http://www.nlm.nih.gov

CANADIAN RESOURCES:

The Canadian Anesthesiologists' Society http://www.cas.ca
Health Canada http://www.hc-sc.gc.ca/index_e.html

References:

Anesthesia & you. American Society of Anesthesiologists website. Available at: http://www.asahq.org/patientEducation/Office-BasedAnesthesiaandSurgery.pdf. Accessed July 27, 2009.
Anesthesia: options and considerations. Mayo Clinic website. Available at: http://www.mayoclinic.com. Accessed September 16, 2003.
Miller RD. Anesthetic techniques. Miller Anesthesia. 7th ed. St. Louis, MO: Churchill Livingstone; 2009: 2223-2231.
Spinal anesthesia. University of Florida website. Available at: http://vam.anest.ufl.edu/simulations/spinalanesthesia.php. Updated April 2009. Accessed July 27, 2009.
6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
12/30/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011;12:CD000331.

Last reviewed September 2012 by Marcin Chwistek, MD

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