How long does rehabilitation take after spinal anesthesia? Consequences and complications of spinal anesthesia

All painful operations and examinations these days are performed under anesthesia.

Modern methods of pain relief are quite complex, so they are performed by anesthesiologists who have undergone special training.

Most often, anesthesia (general anesthesia) or regional anesthesia is performed for pain relief.

Anesthesia turns off pain sensitivity throughout the body, and regional anesthesia - in certain regions (areas) of the body.

Sometimes (if indicated) instead of general anesthesia, spinal anesthesia.

What is spinal anesthesia

Spinal anesthesia means regional method of pain relief, providing complete absence of sensation in the lower half of the body and serving as an excellent alternative to general anesthesia. During this procedure, an anesthetic is injected into the back to “switch off” the pain-conducting nerves.

The advantages of such anesthesia include:

reducing the amount of blood lost during surgery;
reducing the risk of complications such as pulmonary embolism and blood clots;
reducing the negative impact on the lungs and heart;
absence of vomiting, feeling of nausea, weakness;
no pain at the end of the operation;
the opportunity to communicate with the surgeon and anesthesiologist both during and after surgery;
no strict restrictions on food and drink consumption in the postoperative period.

Operating principle

Spinal anesthesia involves the injection of a local anesthetic into the spinal space, which leads to a blockage of the area of the spinal cord located nearby. In other words, the mechanism of action of such anesthesia is not the blockade of the terminal sections of the nerves (epidural anesthesia), but the spinal cord.

Typically, spinal anesthesia carried out at the lumbar level, which leads to the “switching off” of the spinal cord from the lower back - the section of the spinal cord formed by the nerves of the abdomen, perineum and lower extremities.

Video: "What is spinal anesthesia?"

Classification of anesthesia

Under multicomponent anesthesia(anesthesia or general anesthesia) refers to a controlled, toxic, drug-induced coma. This condition is characterized by a temporary shutdown of reflexes, pain sensitivity, consciousness, as well as relaxation of skeletal muscles.

As for local anesthesia, it can be terminal, epidural, infiltration, spinal, conduction, caudal, plexus, intravenous under a tourniquet and intraosseous. Methods of plexus, spinal, intraoblique, conduction, epidural, intravenous under a tourniquet and caudal anesthesia are classified as methods of regional anesthesia.

Regional anesthesia is characterized by turning off conduction in a plexus of nerves or a specific nerve, achieving an analgesic effect while maintaining the patient’s breathing and consciousness. This type of anesthesia may be the only possible method of pain relief if the patient is elderly or has severe concomitant somatic pathologies.

Indications for the use of anesthesia in the back

General anesthesia is applied for major surgical interventions, with large volumes of dental treatment (installation of several implants, multiple tooth extractions, etc.). In such cases, local anesthesia is not used due to the short duration of the effect.

Other indications for general anesthesia may include::

allergy to local anesthetics;
the occurrence of a gag reflex during dental treatment;
presence of panic fear before dental treatment.

As for local spinal anesthesia, it is prescribed for operations in the area below the navel (with the exception of partial or complete amputation of the lower extremities).

Indications for the spinal method of pain relief include::

the need to reduce pain sensitivity during operations on the lower extremities and perineum;
the need to reduce the risk of suffocation or deep vein thrombosis during operations on the lower extremities (for example, a hip fracture in an elderly patient);
the presence of acute and chronic lung diseases;
radicular syndrome (in the lumbar, thoracic and cervical spine)
the need to reduce muscle tone during operations on the small intestine (this makes the surgeon’s work easier);
the need to relax smooth muscles in the walls of blood vessels in people with moderate heart failure (with the exception of patients with arterial hypertension or stenosis of the heart valves).

Spinal anesthesia is often used for caesarean sections., manual separation of the placenta, surgical expulsion of the fetus naturally. With this type of anesthesia, the likelihood of drug exposure to the baby is minimized. In addition, spinal anesthesia allows the woman to remain conscious, hear the baby’s first cry, and immediately after birth go to the general ward.

It also happens that spinal anesthesia fails to completely relieve a woman in labor from pain during a caesarean section. In this case, the patient is transferred to general anesthesia.

Video: "Differences between spinal and epidural anesthesia"

How is anesthesia performed?

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Next fact

Spinal anesthesia begins with the patient being placed in a lateral or sitting position. The choice of position required for pain relief is made by the anesthesiologist. The doctor and his assistant will explain how to take the desired body position and how to behave during the procedure. In particular, it is not recommended to change body position or move until the doctor finishes his work.

Spinal anesthesia consists of several stages:

treating the injection site with a special disinfectant solution;
administration of an anesthetic drug;
performing the manipulation itself (administration of Naropin, Mezaton, Ropivacaine, Lidocaine, Bupivacaine, Novocaine, Buvanestine, Fraxiparine or Norepinephrine).

Typically, spinal anesthesia is performed is not painful and takes 10 to 15 minutes. At the end of the procedure, the patient may feel a slight tingling sensation in the lower extremities (legs, soles of the feet), a feeling of “spreading” warmth.

This phenomenon is considered absolutely normal, so you should not be afraid of it. Soon after this, the legs become “unruly” and heavy (not necessarily), the feeling of pain in the area where the operation is planned disappears.

Sometimes during spinal anesthesia, a painful tingling sensation is felt, similar to a weak electric shock.. If this happens to you, tell the anesthesiologist without turning your head or changing your body position.

Full time restoration of sensitivity in the body depends on the painkiller used. This usually happens within one and a half to four hours.

Getting up from the couch after anesthesia may be difficult (you may feel dizzy). It is advisable that someone close to you or medical staff be nearby at this time. Drinking is allowed 30-60 minutes after surgery, and eating (easily digestible) food in the evening, in agreement with the surgeon.

Side effects and consequences of anesthesia

Compared to general anesthesia, regional anesthesia has a much smaller effect on the body. Therefore, complications during spinal anesthesia are very rare.

The risk of developing complications is determined by factors such as the severity and type of disease, presence of concomitant pathologies, general condition of the patient, bad habits, age.

It is important to understand that absolutely all procedures in anesthesiology (for example, blood transfusions, infusions (“droppers”), installation of a catheter in a central vein, and so on) carry risks. However, this does not mean that the development of complications cannot be avoided.

Possible side effects and complications include:

Headache. After the end of anesthesia and surgery, the person begins to move actively, which can cause headaches. This side effect is observed in 1% of cases. As a rule, the pain goes away on its own within one day. If a headache occurs in the postoperative period, you should measure your blood pressure and act based on its readings. With normal blood pressure, it is recommended to stay in bed and drink plenty of fluids (drinking coffee and tea is acceptable). If you have a very severe headache (which is extremely rare), you should contact a medical professional.
Reduced blood pressure. May be caused by the effects of spinal anesthesia; it does not last long. To increase blood pressure, drinking plenty of fluids and intravenous solutions is prescribed. This side effect occurs in 1% of patients.
Back pain (in the injection area). Treatment, as a rule, does not require. Goes away on its own within the first day. If the pain brings significant discomfort, you can take Diclofenac or Paracetamol. If the pain becomes very severe, you should contact a medical professional.
Urinary retention. Sometimes (mainly in men) difficulties with urination are observed on the first day after surgery. Usually this phenomenon does not require special treatment. However, if you have serious difficulty urinating, it is best to contact the charge nurse.
Neurological disorders. They are extremely rare (less than 1 in 5000 cases). Represents loss of sensation, persistent muscle weakness and/or tingling that persists for more than 24 hours.

To avoid the development of the above side effects, you should follow the recommendations of the anesthesiologist, namely:

Do not drink or eat 6-8 hours before surgery.
Do not smoke for 6 hours before surgery.
Do not paint your nails or apply makeup before surgery.
Remove contact lenses and removable dentures. If you have eye prostheses, you should notify the anesthesiologist about this.
Remove rings, chains, earrings and other jewelry. For believers, it is allowed to leave a simple pectoral cross, but not on a chain, but on a braid.

Failure to comply with these rules increases the risk of complications.

It is important that the anesthesiologist knows about all the patient’s chronic diseases, previous injuries and operations, intolerance to any drugs, allergic reactions. If the patient has recently taken medications, this should also be reported to the doctor. All this information may be useful in preventing complications of spinal anesthesia.

On the eve of surgery, it is advisable to rest, get enough sleep, calm down and spend some time in the fresh air. This will help you get into a positive mood, make the operation easier and speed up recovery after it.

Conclusion

Thus, spinal anesthesia is an excellent alternative to general anesthesia. It “turns off” the lower part of the body and relieves the patient of pain during surgery.

Before performing spinal anesthesia, you should make sure that the patient has no absolute contraindications (sepsis, bacteremia, skin infection at the puncture site, coagulopathy, severe hypovolemia, treatment with anticoagulants, increased intracranial pressure, patient disagreement). If there are none, pain relief can be performed.

note: in the presence of relative contraindications, anesthesia is performed if the expected benefit from its use significantly exceeds the possible harm.

Vertebrologist, Orthopedist

Provides treatment and diagnosis of degenerative-dystrophic and infectious diseases of the spine such as osteochondrosis, hernias, protrusions, osteomyelitis.

A priority position in the anesthetic care of patients with indications for surgical intervention at the lumbar level is occupied by lumbar puncture, as the simplest and safest type of pain relief.

Within the framework of this publication, a definition will be given of what spinal anesthesia is, the technique of implementation will be described, and contraindications and consequences of spinal anesthesia will be described.

Lumbar anesthesia is a type of central conduction anesthesia, and involves turning off pain perception through exposure to segments of the nervous system.

Blockade of innervated zones is achieved by introducing an anesthetic into the subarachnoid space, resulting in a reversible local loss of sensitivity of the spinal nerve roots, while the patient's condition is completely preserved.

Local anesthesia requires endoscopic and puncture interventions on the abdominal organs, reproductive and urinary systems, lower extremities, and pelvis.

The advantages of the method in comparison with traditional general anesthesia are called:

rapid onset of analgesic effect;
maintaining stable geodynamic indicators, insignificant amounts of blood loss;
low likelihood of developing side effects;
the ability to use an epidural catheter for pain relief in the postoperative period;
less need for antibiotics on the first postoperative day;
low cost of the procedure.

Negative point– limited scope (organs of the lower extremities and pelvis), the need to use a mechanical ventilation device in case of technical complications that arose during the operation.

Depending on the location of the anesthetic injection, lumbar anesthesia can be of two types:

Epidural. The puncture is performed at any level of the spine into the space between the dura mater and the periosteum.
Subarachnoid. The anesthetic is administered directly into the subarachnoid space. Blocking the transmission of nerve impulses occurs at the level of the spinal nerve roots.

Reference! What is anesthesia in the back called? Synonymous names for the method of spinal anesthesia are quadral (sacral)/epidural/lumbar anesthesia.

Preparations for spinal anesthesia

Blockade of nerve trunks and plexuses is carried out with medical products with an analgesic effect, varying in effectiveness, toxicity, absorption rate, and duration of action.

The most widely used line of anesthesia in the spine is the following pharmaceutical products:

An ideal drug for spinal anesthesia must meet modern requirements: have low toxicity, demonstrate a high analgesic effect, and have a short latent period.

Today, such a medical product has not been synthesized, so anesthesiologists can use a pharmacological cocktail to achieve the desired result. The components of the solution include adrenergic agonists, B vitamins, opioid and non-opioid analgesics.

How is spinal anesthesia done?

To carry out blockades of the nervous system, special disposable kits are used, which includes a puncture needle, filter, syringe, catheter, adapter. The needles must be sharp, sharpened at an angle of 40-45⁰ in order to determine the location of the needle tip after puncturing the connective tissue membrane.

Reference! The choice of dose to achieve an anesthetic effect requires an individual approach, taking into account patient factors (history, age) and the expected duration of surgery.

An important condition for the successful performance of regional anesthesia is a favorable psycho-emotional mood of the patient. Premedication consists of administering sleeping pills at night, intramuscular injection of psycholeptics, antihistamines or opioid analgesics 30 minutes before surgery.

How to do spinal anesthesia:

Reference! To prevent accidental release of local anesthetic into the vessel, an aspiration test must be performed before injection.

In the early postoperative period, the patient needs medical supervision. A prompt assessment of the patient’s condition consists of recording electrical impulses arising in the heart, blood pressure, heart rate, and systolic blood pressure.

Contraindications

An absolute contraindication to spinal anesthesia is Determination of the following pathological conditions in the patient’s medical history:

Lumbar puncture requires caution elderly weakened people, patients with progressive or severe diseases, including diabetes mellitus, hypertension, renal/liver failure, pathologies of the cardiovascular system. Particular attention should be paid to children of the younger age group.

Reference! It is recommended to administer an anesthetic with increased caution if there is a suspicion of recent spinal injuries or a previous surgical intervention has been determined. These conditions are dangerous due to increased absorption of the drug solution, with resulting results in the form of an increase in its concentration in plasma.

Consequences of spinal anesthesia

Despite the fact that lumbar anesthesia is characterized by its simplicity, accessibility and reliability of blocking pain impulses, it is not without drawbacks: possible complications of spinal anesthesia and adverse reactions.

It is necessary to distinguish negative phenomena from physiological ones, the formation of which is associated with blocking of parasympathetic nerves or a response to the puncture technique.

Side effects of lumbar anesthesia

There are reports of various side effects of spinal anesthesia, most of which are caused not by the action of the anesthetic, but by the technique of performing anesthesia.

Clinically significant should be considered:

dizziness;
nausea, vomiting;
increase/decrease in blood pressure;
urinary retention;
hyperthermia;
feverish condition;
disorder of sensations and perception;
slow heart rate, tachycardia;
allergic phenomena.

When inflated doses of painkillers are administered, there is a suppressive effect on the nervous system and heart muscle, which is manifested by a decrease in automaticity and conduction disturbances.

Reference! Less commonly, but not more than 1 in 10,000 episodes, the consequences of a lumbar puncture can be cardiac arrest.

Complications of spinal anesthesia

If the anesthetic is administered incorrectly or the dosage is deliberately too high, a total spinal block may develop. The development of this condition is predisposed by the technique of performing spinal anesthesia, the anatomical and physiological characteristics of the patient, and the dosage of the drug.

Accidental entry of painkillers into the vascular bed can cause local toxicity. High doses of anesthetic concentrations in the blood are manifested by a symptom complex of disorders of the cardiovascular and nervous system.

Complications identified in the postoperative period include::

spinal subdural or epidural hematoma at the lumbar level;
damage to the spinal cord, nerves of the spinal canal;
radiculopathy;

In especially severe cases, the consequences of intoxication are generalized convulsions, temporary loss of consciousness, and in the worst case, respiratory and cardiac arrest.

When identifying signs of systemic intoxication, it is necessary to immediately interrupt the procedure for turning off pain perception and prescribe adequate therapy in accordance with the patient’s condition.

Why can’t you get up for 24 hours after spinal anesthesia?

Anesthesiologists recommend strict bed rest for the first 24 hours after regional anesthesia.. A common consequence of spinal anesthesia is neurological complications, which include muscle pain and headache.

Post-puncture pain syndrome intensifies in a vertical position and weakens in a horizontal position. Therefore, returning to a standing position on the first postoperative day creates a risk of developing side effects, in particular intense pain.

Important! Another argument why you should not get up for 24 hours after spinal anesthesia is the patient’s predisposition to unstable blood pressure. Returning the body to a horizontal position can cause a decrease in blood flow to the brain.

Why does my head and spine hurt?

Why does my head hurt after spinal anesthesia? The physiological manifestations of spinal anesthesia are postoperative pain syndrome. The mechanism of development of pain impulses is associated with a defect in the dura mater.

Liquor begins to leak through the puncture hole, a drop in intracranial pressure occurs, and as a result, painful sensations in the muscles and headaches appear, which are often combined with hearing impairment, vomiting, and nausea.

What to do if your back hurts after spinal anesthesia. Postpuncture pain syndrome occurs between 12 and 48 hours after puncture, and in half of the clinical cases resolves spontaneously within 5 days. All this time until the pain stops, the patient receives a dose of analgesics.

Reference! For some people, headaches can last up to 10 days. Painful sensations are characterized as intense with a predominant localization in the occipital and frontal zone.

How often can spinal anesthesia be done?

Repeated anesthesia is recommended after healing of the spinal membrane defect. But there are exceptions. If repeated surgical intervention is necessary, secondary spinal anesthesia is allowed, but not before complete absorption of the drug from the cerebrospinal fluid.

If, for medical reasons, repeated lumbar anesthesia is necessary, and adhesions and scars have formed in the area of the puncture puncture, then during the operation the injection is made into a vertebra located at a level above or below the puncture defect.

Conclusion

The generalized results of retrospective studies define spinal blockade as a simple and accessible method of blocking pain impulses, without any particular advantages, but also obvious disadvantages. Lumbar anesthesia can be successful provided that the clinic is equipped at a high level and the specialist is qualified.

Spinal anesthesia is a local anesthesia that is widely used before a variety of surgical interventions. The administration of anesthesia to the back must be carried out in accordance with certain rules. Otherwise, negative consequences may occur.

Features of the procedure

When using anesthesia, the nerves that transmit pain are switched off. This requires the injection of an anesthetic in close proximity to the nerves.

Spinal anesthesia is performed by a highly qualified specialist - an anesthesiologist. It involves injecting an anesthetic into the spinal cord.

During the procedure, the patient must sit or be in a lateral decubitus position. The choice of patient position is made by the anesthesiologist. During the administration of the drug, the patient must remain motionless. Before the anesthetic is administered to the patient, the skin is treated. For this purpose, special disinfectant solutions are used.

A few minutes after the injection of the anesthetic, the patient will feel numbness in the back. Spinal anesthesia not only has an analgesic effect, but also relaxes the muscles. This ensures minimal blood loss during surgery.

Despite the simplicity of the procedure, spinal anesthesia should only be performed by a specialist.

Scope of application of the method

Spinal anesthesia is used only when indicated. In most cases, its use is carried out in the urological and gynecological field.

Spinal anesthesia is not used before amputation surgery. This is explained by the fact that if a person is conscious during such operations, his psyche may suffer. Spinal anesthesia is widely used in surgery due to its many advantages:

During the period of application of the method, a significant decrease in pain sensitivity in the groin and legs is observed.
Spinal anesthesia is permitted for patients diagnosed with acute or chronic pulmonary diseases.
Using this method, a significant decrease in muscle tone in the acute intestine is achieved if surgery is performed on this organ.
Spinal anesthesia eliminates the possibility of suffocation in patients.
During the use of this method, the possibility of blood clots in the lower extremities is eliminated.
Spinal anesthesia can be used for people who suffer from heart failure, which is explained by the relaxation of the walls of blood vessels.
Spinal anesthesia is widely used for caesarean section when there is a need for the baby to be born quickly. This procedure is safe and has minimal impact on the baby’s health. If the patient has a high pain threshold, spinal anesthesia may not be effective enough. In this case, general anesthesia is used.

Spinal anesthesia is quite effective and is characterized by a large number of advantages.

Significant contraindications

Despite the effectiveness of anesthesia, this technique has certain contraindications. This is because the procedure requires the administration of an anesthetic substance, which can lead to certain consequences.

If the body is dehydrated, it is not recommended for patients to use this method of pain relief. Also, a contraindication to the procedure is the loss of a large amount of blood.
Doctors do not recommend the use of spinal anesthesia for patients diagnosed with heart defects.
If the patient has low blood clotting, then this method is not used before surgery.
If intracranial pressure increases, the use of spinal anesthesia is strictly prohibited.
It is not recommended if you have allergic reactions to the products necessary for its implementation.
If the patient has diseases of the spinal column, then this method is not recommended.
If there are skin rashes at the injection site, anesthesia is not used.
During childbirth, in some cases, the use of spinal anesthesia is prohibited. If fetal hypoxia or malformations are observed, then this method is contraindicated in women.
It is not used in the presence of neurological or psychological disorders.

Anesthesia is characterized by the presence of a large number of contraindications that must first be taken into account. Otherwise, the patient may experience undesirable consequences.

Consequences and complications

Improper implementation of the procedure often leads to various undesirable effects. Patients are often diagnosed with complications after spinal anesthesia, which manifest themselves as:

Headaches. The appearance of pain in the head after spinal anesthesia indicates a decrease in cerebrospinal fluid pressure. Also, this pathological condition can occur against the background of irritation of the meninges. Such side effects occur in 10 percent of cases of anesthesia.
Interosseous ligamentosis. When using anesthesia, patients may experience severe back pain. They are observed not only at the puncture site, but also in the area of the entire spinal column. This complication occurs due to traumatic manipulations, repeated puncture, and aseptic inflammation. If back pain occurs after anesthesia, treatment is not carried out. These negative symptoms will go away on their own within a few weeks. If the pain syndrome persists, darsonvalization of the puncture site is performed. Electrophoresis using magnesium is also quite effective in this case. Back pain may also occur after general anesthesia is used.
Spinal cord or root injuries. These symptoms most often occur after the use of anesthesia. The puncture itself may cause injury. As a result, neurological complications often occur. During the procedure, patients complain of pain in the nerve trunks.
Hypotension. The severity of hypotension directly depends on the level of anesthesia, as well as the necessary preventive manipulations and the features of their implementation. When performing infusion support before surgery, anesthetic drugs must be injected into the subarachnoid area. In this case, dangerous hemodynamic disturbances will not occur. If severe hypotension develops in elderly people, sodium chloride is administered intravenously over several minutes. The dosage of the drug is determined by the doctor. It usually ranges from 3 to 3.5 milliliters per kilogram of human weight. If preventive measures are absent, this will lead to the development of a severe form of hypotension. In this case, it will be necessary to carry out correction with adrenomimetic and colloid medications.
Respiratory depression. If narcotic anesthetics are used during anesthesia, this can lead to respiratory depression. The intensity of the depressive respiratory effect is directly affected by the dosage of the drug. To avoid the occurrence of respiratory depression, it is necessary to strictly adhere to the dosage of the drug, which is administered with the patient in a sitting position. To eliminate the undesirable effects of drug administration, the use of Naloxone is recommended.
Prolonged headaches after surgery. The use of this anesthesia during cesarean section quite often causes migraines or severe headaches. In most cases, side effects are observed in young women who are light. Also, the pathological condition can occur in a variety of endocrine diseases. The appearance of headaches is most often observed 2-3 days after surgery. To eliminate them, patients need to drink fluids in large quantities.
Cauda equina syndrome. If paresthesia occurs during the manipulation, this undesirable effect will be observed. When a complication occurs, in most cases, patients complain of loss of sensitivity in intimate areas, urinary incontinence, and leg paresis of varying severity. The appearance of the pathological condition is observed several days after surgery. Symptoms go away on their own within 2 weeks.
Deafness. After the manipulation, the patient may experience vestibular disorders. Patients complain that their hearing is deteriorating, and in some of them it completely disappears. This is explained by the fact that the pressure in the inner ear and cerebrospinal fluid pressure are significantly reduced. To treat this pathological condition, the epidural space is filled with autologous blood. Also in this case, infusion therapy can be used.
Aseptic meningitis. After machinipulation, signs of aseptic meningitis may be observed in the form of headache, stiffness of the neck muscles, photophobia, and hyperemia. These symptoms are observed in the patient for a week. If the patient's neck is immobile, in most cases one can judge aseptic meningitis.
Adhesive arachnoiditis. It is a fairly serious complication. When it appears during spinal anesthesia, surgical intervention is required. With its help, the symptoms and manifestations of the disease are relieved. Arachnoiditis is manifested by loss of sensation in the legs, against the background of which complete paraplegia can develop.
Various neurological disorders. As a rule, this complication occurs for no more than two days. If unpleasant symptoms do not go away for a long period, then the functioning of the nervous system is not completely restored.
Pain at the injection site. When this symptom appears, it can be judged that quite dangerous complications are developing. But, in most cases, the pain goes away on its own and does not entail negative consequences.
After administration of anesthesia, cardiac arrest is observed in rare cases. This is a serious complication that requires immediate medical attention. Otherwise, the person will die. Many patients complain that after the administration of anesthesia their hair begins to fall out. This procedure can lead to vision problems, which can lead to the development of a scotoma.

Spinal anesthesia is the method of choice for many surgical procedures performed below the navel. This type of pain relief is best suited for elderly people with chronic obstructive pulmonary disease, endocrine, and renal disorders.

Indications for SA:

Operation below the navel level;

Surgical intervention on the perineum;

C-section;

Operations on the lower extremities, except amputation;

Gynecological and urological operations.

Contraindications:

Patient refusal;

Blood clotting disorder;

Infection at the puncture site;

Cardiac conduction disturbances;

Peripheral neuropathy;

Multiple sclerosis;

Spinal deformity;

Sepsis, meningitis.

Spinal anesthesia: preparation for the procedure

Preparation consists of talking with the patient and obtaining consent for the procedure. Immediately before anesthesia, premedication is administered.

Spiral block kit:

Spinal needle with guide (introducer);

A syringe for anesthetizing the puncture site;

Syringe for intrathecal anesthesia;

Sterile gloves, alcohol, cotton wool, gauze ball and plaster;

Anesthetic (Marcaine, Bupivacaine, Lidocaine).

Spinal anesthesia: patient position

Two main provisions are used:

Lying on your side. The position is most often used in anesthesiological practice. The patient should be bent as far as he can, with his knees close to his body and his chin close to his chest. The patient's back should be on the edge of the operating table.
In a sitting position. The patient sits on the edge of the operating table, with his legs positioned on a stand. The torso is bent as far as possible to the knees, the chin should touch the chest, and the arms should be crossed on the stomach.

Spinal anesthesia: technique of execution

The puncture site is treated with ethyl alcohol. Then wipe with a dry gauze cloth. After that, a local anesthetic is injected at the site of the intended injection for superficial pain relief. Next, a puncture is made with a needle for neuraxial anesthesia and it is advanced along the midline to the spine. Advance until the assistant feels a failure; after removing the introducer, cerebrospinal fluid should appear. As quickly as possible, a syringe containing an anesthetic is attached to the needle and slowly injected into the spinal cord. After the anesthetic is administered, the needle and syringe are removed and a sterile gauze bandage is applied at the puncture site, securing it with a bandage.

Spinal anesthesia. Complications:

Arterial hypotension and decreased heart rate (bradycardia);

Breathing disorders (apnea);

Epidural abscess, meningitis;

Traumatic spinal cord injury;

Epidural hematoma;

Neurotoxic disorders (toxic effect of local anesthetic on nerve fibers);

Ischemic disorders occur when adrenaline is used as an adjuvant;

Postpuncture syndrome.

Spinal anesthesia: consequences

A common long-term consequence of intrathecal anesthesia is post-puncture headache. The cause is the leakage of cerebrospinal fluid through the dura mater into the epidural space. The consequence of this process is not only severe headache, but also nausea, vomiting, and dizziness. In order to prevent such phenomena, the operator must use thin needles of 25-27 G for neuraxial anesthesia. If such consequences of anesthesia occur, immediate treatment begins. It consists of constant bed rest, infusion therapy in a volume of up to two liters per day, drinking plenty of fluids, using caffeine and non-steroidal anti-inflammatory drugs. The headache may last from 10 to 14 days.

In the article we will consider the consequences of spinal anesthesia and reviews.

Any surgical interventions and procedures that cause pain are performed in modern medicine under anesthesia. The type of anesthesia is determined by the type, duration of the operation, and the condition of the patient as a whole. There are two types of anesthesia - general anesthesia and spinal anesthesia, in which a certain area of the body loses sensation.

According to reviews, spinal anesthesia is more preferable in some cases.

Description

If during an operation it is necessary to deprive the lower part of the human body of sensitivity, then spinal anesthesia is performed. The essence of this method is the introduction of an anesthetic into a certain area near the spinal cord (in the back - that’s why this method came to be called that way). This is the subarachnoid space, which is located between the spinal cord and the meninges, it is filled with cerebrospinal fluid.

A huge number of large nerves pass through the cerebrospinal fluid; the transmission or pain signals to the brain must be blocked. Spinal anesthesia is performed in the lumbar region, the area below the lower back is numbed. The anesthesiologist should pass the needle to the spine, the ligaments between the vertebrae, the epidural and the meninges, then inject the selected anesthetic.

There are numerous reviews of caesarean section with spinal anesthesia.

Technique for performing spinal anesthesia

To carry out this method of anesthesia, a special (spinal) needle, very thin, a selected anesthetic and a syringe are used. A very significant point is the correct positioning of the patient’s body. Attention is focused on this during spinal and epidural anesthesia to avoid incorrect punctures.

Spinal anesthesia has the following technique: anesthesia is administered into the spine in the following position: the patient sits (you need to bend your back, press your chin to your chest, bend your arms at the elbows) or lie on your side. A sitting position is preferable; the spinal area is better visible. Complete immobility is required to avoid complications during spinal anesthesia. Before administering anesthesia to the back, the specialist will use palpation to determine the optimal area for the injection (this is the area between the third, fourth and fifth vertebrae).

To prevent infection or blood poisoning, the area where subdural anesthesia will be performed is treated with special preparations; complete sterility is required. It is done in the area where the spinal needle is inserted. For this procedure, the needle is distinguished by its length (about thirteen centimeters) and small diameter (about one millimeter), so local anesthesia is not used in some cases. The needle is inserted very slowly, passing through all the skin layers, the epidermal layer, and the hard membrane. The trajectory of the needle stops upon entering the subarachnoid cavity, and the mandrel is pulled out of it (that is, the conductor that closes its lumen). If the action is performed correctly, the cerebrospinal fluid flows out of the needle cannula; the anesthetic is injected, the needle is removed, and the injection site is covered with sterile materials.

Immediately after using the medicine, a person may feel a side effect: tingling in the legs, a feeling of warmth (it will last for some time - a natural effect of pain relief). Unlike epidurals, complete anesthesia during spinal cord anesthesia occurs within ten minutes; the type of drug determines the duration of the anesthesia and depends on the duration of the intervention.

Spinal anesthesia agents

Spinal anesthesia is carried out using different drugs: adjuvants and anesthetics themselves (the former are additives). A common drug for pain relief of this type is Lidocaine. It is suitable for short interventions. Used along with fentanyl, it allows you to provide a tenth degree block for 30-45 minutes. "Procaine" is a short-acting medicine. A 5% solution is used. To enhance the blockade, it is combined with fentanyl.

The drug "Bupivacaine". Its specificity is the relative signs of action. The period of blockade level lasts up to an hour, more extended dosages can be used (starting from five milligrams or more).

"Naropin". Used for long-term interventions. Spinal anesthesia can be done with a solution of 0.75% (from 3 to 5 hours of influence) and 1% (from 4 to 6).

Adjuvants: adrenaline (extends block time), fentanyl (increases the anesthetic effect); in some cases, morphine or clonidine is used as an additive.

Spinal anesthesia for caesarean section

An operation such as a caesarean section is the removal of the baby with the patient being under anesthesia. Spinal anesthesia for caesarean section eliminates the possibility of the drug affecting the child. Kreis used spinal anesthesia for the first time for caesarean section in 1900. Epidural and spinal anesthesia are used almost everywhere when there are no contraindications. According to reviews, cesarean with spinal anesthesia is absolutely painless.

Difference from epidural anesthesia

The injection is given once during neuraxial anesthesia (this is the main difference from the epidural technique, in which a catheter is inserted to administer the medication). Contraindications to the use of this method are the following: a reduced level of platelets in the blood, poor blood clotting, heart rhythm disturbances, infectious processes in the area of drug administration. Recovery occurs quickly. The differences and main advantage, when compared with general anesthesia, are the extremely low likelihood of dangerous complications for the mother and child, and relatively little blood loss.

Reviews about the consequences of spinal anesthesia for caesarean section should be read in advance.

During childbirth

The most common method of labor pain relief is spinal anesthesia. Its main purpose is to eliminate pain during labor, create safety and comfort for the child and the woman in labor. The drug is injected into the lumbar area, suppressing pain. In this case, the time is calculated in such a way that the effect of the drug decreases during the period of pushing, the only exception is a high degree of myopia in a woman and heart defects. It is advisable to do lumbar anesthesia:

if a woman is not psychologically ready for childbirth;
if the fruit is large;
at the birth of the first child;
in case of premature birth;
for stimulation: when labor is absent after the amniotic fluid has ruptured.

According to reviews, spinal anesthesia during childbirth is simply irreplaceable. The whole process is much easier thanks to her.

Contraindications for spinal anesthesia

Spinal anesthesia has various contraindications; they can be divided into two types: relative and absolute. Relative contraindications include:

emergency situations when there is no time to carry out the required preparatory procedures with the patient;
the patient's unstable mood (lability);
abnormal defects of the vertebral structure;
malformations of the baby or fetal death;
high pressure inside the skull;
the likelihood of bleeding, as well as the uncertain time of surgical intervention;
hypoxia, pathologies of the central nervous system.

Absolute contraindications for this type of pain relief are:

categorical reluctance of the patient;
allergic reaction to anesthetics;
lack of resuscitation conditions and insufficient lighting;
skin infections: meningitis, herpes, sepsis;
intracranial hypertension.