This guide is written by the Royal College of Anaesthetists. Used here with permission.
This leaflet explains:
For many operations, patients receive a general anaesthetic which produces a state of controlled unconsciousness during the operation. A spinal anaesthetic (“a spinal”) may be used instead for some operations below the level of the waist. 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:
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.
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.
Only when both you and the anaesthetist are completely happy that the anaesthetic has taken effect will you be prepared for the operation.
Advantages there may be:
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.
As with all anaesthetic techniques there is a possibility of unwanted side effects or complications. People vary in how they interpret words and numbers. This scale is provided to help:
|Very common||Common||Uncommon||Rare||Very rare|
|1 in 10||1 in 100||1 in 1,000||1 in 10,000||1 in 100,000|
These may be unpleasant, but can be treated and do not usually last long.
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. Headache – There are many causes of headache, including the anaesthetic, the operation, dehydration and anxiety. Most headaches get better within a few hours and can be treated with pain relieving medicines. Severe headache can occur after a spinal anaesthetic. If this happens to you, your nurses should ask the anaesthetist to come and see you. You may need special treatment to settle the headache.
Nerve damage –This is a rare complication of spinal anaesthesia. Temporary loss of sensation, pins and needles and sometimes muscle weakness may last for a few days or even weeks but almost all of these make a full recovery in time. Permanent nerve damage is even more rare and has about the same chance of occurring as major complications of general anaesthesia.
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. The hospital should give you clear instructions about fasting.
Before the operation you and your anaesthetist can decide together whether you remain fully awake during the operation or would prefer to be 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.
Sometimes you can choose. Normally a screen is placed across your upper chest so that you see nothing when surgery starts. Some operations use video cameras and telescopes for “keyhole” surgery and many patients like to see what is happening to them on the video screen. 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. The options available to you will vary, depending on a number of factors to do with your operation. You will be able to discuss all these possibilities with your anaesthetist at the preoperative visit.
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.
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.
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.
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.
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.
This leaflet is designed to give you a brief overview about your spinal anaesthetic. If you would like more detailed information, speak to your anaesthetist or contact the anaesthetic department in your local hospital or the organisations listed at the bottom of this leaflet.
21 Portland Place
London W1B 1PY
Phone: +44 20 7631 1650
Fax: +44 20 7631 4352
This organisation works to promote the development of anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland.
35 Red Lion Square
London, WC1R 4SG
Phone: + 44 20 7092 1500
Fax: + 44 20 7092 1730
This organisation is responsible for standards in anaesthesia, critical care and pain management throughout the UK.
c/o Department of Anaesthetics
The Alexandra Hospital
Worcestershire B98 7UB
Tel/Fax: 01527 512047
This organisation works to further regional anaesthesia in Europe.
This guide was written by The Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, London WC1R 4SG.
© 2002, RCoA (3rd edition - May 2008). Copyright for this article is with the Royal College of Anaesthetists.