What Is Spinal Anesthesia?

Spinal anesthesia is one of the regional techniques used to remove pain temporarily from a specific part of the body. It is often known simply as "numbing from the back".

The anesthetic drug is delivered into the area containing the cerebrospinal fluid, producing effective numbness in the lower half of the body.

The patient is usually awake during spinal anesthesia, though they can be made more comfortable, or made lightly drowsy, with additional medication if they wish.

Spinal anesthesia and general anesthesia are therefore different methods.

How does it work?

Pain signals from the body travel through the nerves to the spinal cord and from there to the brain.

The drug used in spinal anesthesia temporarily stops that nerve conduction, so pain signals from the surgical area cannot reach the brain. The patient feels no pain.

Depending on the area treated, loss of movement can also occur. This effect is temporary and returns to normal as the drug wears off.

Which operations is it used for?

Spinal anesthesia is preferred particularly for operations involving the lower half of the body. For example:

• Caesarean sections
• Knee replacement surgery
• Hip replacement surgery
• Urological procedures
• Some general surgery procedures
• Lower limb orthopedic operations

For these operations it can be an effective and reliable option.

Is the patient awake?

Yes. This is one of the defining features of spinal anesthesia.

The patient keeps breathing independently throughout, can hear what is happening and can speak.

Not every patient prefers this, however. Sedation can therefore be added, so that the patient feels more comfortable and may even spend most of the operation asleep.

How is it given?

The procedure is usually carried out with the patient sitting or lying on their side.

The lower back is cleaned with antiseptic solution. Using a fine needle, the area containing the cerebrospinal fluid is reached and the anesthetic drug is given. The procedure usually takes a few minutes.

Shortly afterwards a feeling of warmth, numbness and reduced movement appears in the legs. This shows that the drug has started to work.

Are spinal and epidural anesthesia the same?

No. These two methods are often confused.

Both are given in the lower back, but the space the drug is delivered into is different.

In spinal anesthesia the drug goes directly into the area containing the cerebrospinal fluid. In epidural anesthesia it goes into the epidural space surrounding the spinal cord.

Epidural anesthesia also allows a catheter to be placed so the drug can be given over a longer period. The two methods resemble each other but are not the same.

What are the advantages?

They do not apply to every patient, but spinal anesthesia has certain advantages. For example:

• General anesthesia may not be needed
• Breathing function may be less affected
• It can contribute to pain control after surgery
• Nausea and vomiting may be less frequent in some patients
• It can allow a more comfortable early recovery

Which method is more suitable must always be assessed according to the patient and the operation.

Are there risks?

As with any medical procedure, spinal anesthesia carries certain risks and side effects. These include:

• A drop in blood pressure
• Headache
• Nausea
• Temporary difficulty passing urine
• Itching

Serious complications are rare. The purpose of anesthesia planning is to reduce these risks as far as possible.

Can spinal anesthesia cause paralysis?

This is one of the questions anesthesiologists encounter most often. The short answer: paralysis is not an expected outcome of spinal anesthesia.

Misinformation circulating for years has created the perception that spinal anesthesia causes paralysis. In modern practice, permanent nerve damage is among the extremely rare complications.

As with any medical procedure the risk is not zero, but spinal anesthesia has been performed safely worldwide for many years.

Why does headache occur afterwards?

Headache is one of the best-known side effects that can follow spinal anesthesia. It is related to pressure changes in the cerebrospinal fluid.

Thanks to the fine needles used today, this risk has fallen markedly. If a headache does develop it is usually temporary and can be controlled with appropriate treatment.

How long until you can walk?

This varies with the drugs used and the operation performed. Movement in the legs generally begins to return within a few hours.

The decision to stand and walk depends not only on the anesthesia wearing off, but also on the type of surgery and the surgeon's advice.

Is it suitable for everyone?

No. In some situations spinal anesthesia may not be preferred. For example:

• In patients taking blood thinners
• In some bleeding disorders
• If there is infection at the injection site
• In some neurological conditions

Different methods may be chosen in those cases. The anesthesia method is always planned individually.

Spinal anesthesia and patient preference

In anesthesia planning, the patient's preferences matter as much as the medical requirements.

Some patients want to stay awake during surgery; others do not. Where appropriate, adding sedation to spinal anesthesia lets the patient benefit from its advantages while going through the operation more comfortably.