Many people have surgery requiring an anesthetic that numbs specific areas of the body.
Spinal anesthesia can be effective in certain kinds of operations such as leg or prostate surgeries.
If your doctor recommends surgery with spinal anesthesia, the decision whether or not to have the procedure is also yours.
This module will explain the benefits and risks of this anesthetic.
ANATOMY
The spine is formed of vertebrae, or small bones.
The vertebrae are separated and cushioned by softer disks. This allows the spine to flex and bend.
Nerves pass from the body to the brain through the spine.
They carry sensations, including the sensation of pain to the brain.
The aim of this type of anesthesia is to put medications around the nerves to stop the feeling of pain.
This medication will make you unable to move your legs. They will feel numb. You may not be able to control your bladder and may have a catheter placed in the bladder to drain the urine. All of this is expected during this anesthetic.
The feelings in your legs and the ability to move them will come back to normal as soon as the anesthetic wears off. This may take few hours.
THE PROCEDURE
To prevent you from feeling pain during your surgery, your anesthesiologist will place the medication around the nerves in the fluid that bathes them.
Initially, an IV is placed in your arm or hand to administer medications to help you relax and treat blood pressure changes if necessary.
Before the back injection, the skin is disinfected and numbed with local anesthesia (similar to Novocaine® used by dentists), so that you will not feel the pain of the spinal injection.
A minute or so later, the medication is injected with a longer needle directly around the nerves.
This is usually not painful, although it may be uncomfortable.
Rarely, this kind of anesthesia may not be possible to administer because of severe arthritis in the spine. A general anesthetic is then given.
During this part of the procedure, you should let your doctor know if you have any pain, especially in the legs. Pain may mean the needle is touching a nerve.
You will also be given some medications through the IV to relax you, and possibly make you sleep.
Throughout the operation, the anesthesiologist very closely monitors your heart rate and tracing, blood pressure, and oxygen concentration in the blood with the help of medical instruments called ‘monitors.’
If your anesthesiologist chooses to make you sleep, you will be allowed to wake up when the operation is done. You will then be taken to the recovery room where nurses will watch over you until you are fully awake.
RISKS AND COMPLICATIONS
Because of significant advances in technology and medications, this anesthetic is extremely safe. There are however some possible risks and complications. YOU can do a lot to prevent them.
You should make your anesthesiologist aware of any medical problems that you may have such as heart, lung, or kidney problems, strokes, liver damage, and other similar problems.
It is also very important to make your anesthesiologist and surgeon aware of any medications you are taking such as blood thinners (Coumadin®) or over-the-counter medications such as aspirin or Advil®. Some of the medications you may be taking could interact with anesthesia medications or could cause you to bleed excessively during surgery.
It also is extremely important to tell your doctors whether you have any allergies to medications, such as numbing medications, or to food groups (such as eggs). This allows your doctors to stay away from medications that you may be allergic to.
Because rare reactions to anesthesia may run in families, it is extremely important to let your doctor know whether you or ANY member of your family have had any troubles with anesthesia in the past.
It is not uncommon to have some nausea and vomiting after surgery. This is usually dealt with using anti-nausea medications.
There is a very small risk of lung infections, strokes, heart attacks, and possibly death during or after anesthesia. These risks are very rare but are more likely in older people and patients who have medical problems.
Blood clots in the legs can occur due to inactivity during and after the surgery. These usually show up a few days after surgery. They cause the leg to swell and hurt.
Blood clots can become dislodged from the leg and go to the lungs where they will cause shortness of breath, chest pain and possibly death. It is extremely important to let your doctors know if any of these symptoms occur. Sometimes the shortness of breath can happen without warning. Getting out of bed shortly after surgery may help decrease the risk of blood clots in the legs.
Because the body lies still during surgery, pressure points may develop if a part of the body gets too much pressure. This can, rarely, result in nerve damage, paralysis, blindness, and skin ulcers. Precautions are taken to prevent these complications.
You will experience mild pain at the site of the injection for a few days after the injection.
Rarely, the site of your IV can become infected. This is usually of little consequence but may need to be treated with warm cloth applications or antibiotics. On rare occasions, pain over the involved vein may last for months.
Since the procedure involves puncturing the covering around the spinal nerves (the thecal sac), some patients develop severe headaches.
If this happens, let your doctor know. You may have to lie flat for some time and drink lots of fluids. If this does not help, some of your own blood may be used to stop the fluid leak. This very simple procedure is called ‘blood patch’.
In very rare cases infections may occur. Therefore, it is important to report to your doctor any worsening pain, fever, headache, or neck stiffness.
Finally, the injection may cause internal bleeding, which puts pressure on the nerves. The chance of this happening is again extremely rare, but if you develop significant new weakness or a bladder problem, you should tell you doctor.
Your anesthesiologist is prepared to treat reactions to medications used in the operating room. In spite of the best effort, in very rare instances these reactions could be fatal. It is therefore very important to inform your anesthesiologist of all your known allergies.
It is very rare for a patient to have persistent back pain from this procedure. If you have had any back troubles, you need to let your anesthesiologist know prior to proceeding with spinal anesthesia.
Rarely, the anesthesiologist may have to switch to general anesthesia. This includes putting a tube down the windpipe to aid in breathing.
You will be sound asleep in case this happens, and the tube is usually taken out as soon as you are fully awake and able to breathe on your own.
In the case of the tube being placed in the throat, the throat may feel sore afterwards. While the tube is inserted in the mouth, the lips, the vocal cords, and even the teeth may be damaged. This is extremely rare.
If excessive bleeding occurs during surgery, the anesthesiologist, in close consultation with the surgeon, may decide to give you a blood transfusion. This is done only in very extreme conditions.
This blood is thoroughly tested for known communicable diseases such as hepatitis or AIDS. This blood is very safe, but infections with these known or other unknown diseases could still happen. If for religious or other reasons you are against blood transfusions, even in life-threatening situations, make sure to tell your doctors prior to surgery.
Be sure to tell your anesthesiologist if there is any chance you may be pregnant. Special precautions may need to be taken during the operation.
SUMMARY
Spinal anesthesia is very safe. However, as you have learned there are some risks and possible complications.
As you have also learned, you have to let your doctors know in case of fever, signs of infection, shortness of breath, swelling in the legs, or any other new symptoms that you may have after your surgery.
Most of the complications can be prevented through good communication. Make sure to inform your doctors of all your medical conditions, medications, and allergies. Your family history as it relates to anesthesia is also VERY important.
Complications may happen. Knowing about them will help you and your doctor detect them early if they happen.
