How long does it take to recover from spinal anesthesia? Consequences and complications of spinal anesthesia

All painful surgeries and examinations are now performed under anesthesia.

Modern methods of anesthesia are quite complex, therefore they are performed by anesthesiologists who have undergone special training.

Most often, anesthesia is performed under anesthesia (general anesthesia) or regional anesthesia.

Narcosis 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 anesthesia, providing a complete absence of sensations 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, which “turns off” the nerves that conduct pain.

The benefits of this pain relief include:

reduction in the amount of blood lost during surgery;
reduced risk of complications such as pulmonary embolism and blood clots;
reducing the negative impact on the lungs and heart;
lack of vomiting, feelings of nausea, weakness;
no pain at the end of the operation;
the ability to communicate with the surgeon and anesthetist both during and after surgery;
the absence of strict restrictions on the use of food and drinks in the postoperative period.

Operating principle

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

Usually spinal anesthesia carried out at the level of the lumbar, which leads to the “switching off” of the spinal cord from the lower back and below - a 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(narcosis or general anesthesia) refers to 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, intraosseous, conduction, epidural, intravenous tourniquet and caudal anesthesia are classified as methods of regional anesthesia.

Regional anesthesia is characterized by switching off conduction in the nerve plexus or a specific nerve, achieving the effect of anesthesia 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 surgery, with large volumes of dental treatment (installation of several implants, multiple extractions of teeth, etc.). In such cases, local anesthesia is not used due to the short duration of the effect.

Other indications for general anesthesia may be:

allergy to local anesthetics;
the occurrence of a gag reflex during dental treatment;
the presence of a panic fear of 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 spinal anesthesia 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, with a fracture of the femoral neck 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 facilitates the work of the surgeon);
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 valvular stenosis).

Often spinal anesthesia is used for caesarean section., manual separation of the placenta, surgical expulsion of the fetus in a natural way. With this type of anesthesia, the likelihood of drug exposure to the baby is minimized. In addition, spinal anesthesia allows a woman to remain conscious, hear the baby's first cry, and immediately after childbirth go to the general ward.

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

Video: "Differences between spinal and epidural anesthesia"

How anesthesia is performed

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Next fact

Spinal anesthesia begins with the patient placed in a supine or sitting position. The choice of the position required for anesthesia is made by the anesthesiologist. The doctor and his assistant will explain how to assume the correct body position and how to behave during the procedure. In particular, it is not recommended to change the position of the body and move until the doctor has finished his work.

Spinal anesthesia is performed in several steps.:

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

Typically, spinal anesthesia is not painful and takes 10 to 15 minutes. At the end of the procedure, the patient may feel a slight tingling in the lower extremities (legs, soles of the feet), a feeling of "overflowing" heat.

This phenomenon is considered absolutely normal, so you should not be afraid of it. Soon after that, the legs become "naughty" and heavy (not necessarily), the sensation of pain disappears in the area where the operation is planned.

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

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

It may be difficult to get up from the couch after anesthesia (possibly dizziness). It is desirable that at this time there was someone from relatives or medical staff nearby. Drinking is allowed 30-60 minutes after the operation, and eating (easily digestible) - 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 complications is determined by factors such as the severity and type of disease, the presence of concomitant pathologies, the 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”), placement of a catheter in a central vein, and so on) carry a risk. However, this does not mean that the development of complications cannot be avoided.

Possible side effects and complications include:

Headache. At the end of anesthesia and surgery, the person begins to actively move, which can provoke headaches. This side effect occurs in 1% of cases. The pain usually resolves on its own within one day. If a headache occurs in the postoperative period, blood pressure should be measured and acted on based on its indicators. With normal blood pressure, it is recommended to observe bed rest and drink plenty of fluids (coffee and tea are acceptable). With a very severe headache (which is extremely rare), you should contact the medical staff.
Decreased blood pressure. May be caused by the action of spinal anesthesia, it is observed for a short time. To increase the pressure, plenty of fluids and intravenous administration of solutions are prescribed. This side effect occurs in 1% of patients.
Back pain (in the injection area). Treatment, as a rule, does not require. It goes away on its own within the first day. If the pain brings tangible discomfort, you can take Diclofenac or Paracetamol. If the pain becomes very severe, you need to contact the medical staff.
Urinary retention. Sometimes (mainly in men) on the first day after surgery, there are difficulties with urination. Usually this phenomenon does not require special treatment. However, if you have serious problems with urination, it is best to contact the nurse on duty.
neurological disorders. They are extremely rare (less than 1 in 5,000). They are 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 the operation.
Do not paint nails or apply cosmetics before surgery.
Remove contact lenses and removable dentures. In the presence of ocular prostheses, it is worth warning 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 follow these rules increases the risk of complications.

It is important that the anesthesiologist is aware of all chronic diseases of the patient, past 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 can be useful in preventing complications of spinal anesthesia.

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

Conclusion

In this way, spinal anesthesia is a great alternative to general anesthesia. It "turns off" the lower part of the body and relieves the patient of pain during the operation.

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, anticoagulant treatment, increased intracranial pressure, patient disagreement). If these are not available, anesthesia can be performed.

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

Vertebrologist, Orthopedist

Carries out treatment and diagnostics of degenerative-dystrophic and infectious diseases of the spine such as: osteochondrosis, hernia, protrusion, osteomyelitis.

Lumbar puncture occupies a priority position in the anesthetic management of patients with indications for surgical intervention at the lumbar level, as the simplest and safest type of anesthesia.

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

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

The blockade of the 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 is required for endoscopic and puncture interventions on the organs of the abdominal cavity, reproductive and urinary systems, lower extremities, and small pelvis.

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

rapid onset of analgesic effect;
maintaining stable indicators of geodynamics, insignificant volumes 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 in the first postoperative day;
low cost of the procedure.

Negative point- limited scope (organs of the lower extremities and small pelvis), the need to use a ventilator in case of technical complications that arose during the operation.

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

epidural. The puncture is performed at any level of the spine in the space between the dura mater and the periosteum.
subarachnoid. The introduction of the anesthetic drug is carried out directly into the subarachnoid space. Blocking the transmission of nerve impulses occurs at the level of the roots of the spinal nerves.

Reference! What is back anesthesia called? Synonymous names for the method of spinal anesthesia will be caudal (sacral) / epidural / lumbar anesthesia.

Preparations for spinal anesthesia

The blockade of the nerve trunks and plexuses is carried out by medical products with an analgesic effect, different in efficiency, toxicity, absorption rate, duration of action.

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

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

To date, such a medical product has not been synthesized, so anesthesiologists can use a pharmacological cocktail to achieve the desired result. Adrenomimetics, B vitamins, opioid and non-opioid analgesics are included as components in the composition of the solution.

How spinal anesthesia is done

For blockades of the nervous system, special disposable kits are used, which includes a puncture needle, filter, syringe, catheter, adapter. Needles should be sharp, sharpened at an angle of 40-45⁰ to locate the needle tip after puncture of the connective tissue sheath.

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

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

How spinal anesthesia is done:

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

In the early postoperative period, the patient needs medical supervision. Rapid assessment of the patient's condition consists in recording electrical impulses that occur in the work of the heart, blood pressure, heart rate, systolic blood pressure.

Contraindications

An absolute contraindication to spinal anesthesia is determination in the patient's history of the following pathological conditions:

Caution in lumbar puncture requires elderly debilitated people, patients with progressive or severe diseases, including diabetes mellitus, hypertension, renal / hepatic insufficiency, pathologies of the cardiovascular system. Particular attention should be paid to children of the younger age group.

Reference! With increased caution, it is recommended to administer an anesthetic if a recent spinal injury is suspected, and a previous surgical intervention is determined. These conditions are dangerous by increasing the absorption of the drug solution, with the ensuing results in the form of an increase in its plasma concentration.

Consequences of spinal anesthesia

Despite the fact that lumbar anesthesia is simple, accessible and reliable in 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 due not to the action of the anesthetic, but to the technique of performing anesthesia.

Clinically significant are:

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

With the introduction of excessive doses of painkillers, there is an overwhelming effect on the nervous system, the heart muscle, which is manifested by a decrease in automatism, impaired conduction.

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

Complications of spinal anesthesia

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

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

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, in the worst case, respiratory arrest, cardiac arrest.

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

Why you can't 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 a neurological complication that manifests itself as muscle pain and headache.

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

Important! Another argument why it is impossible to get up for a day 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 the head and spine hurt

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

The liquor begins to leak through the puncture hole, intracranial pressure drops, as a result, there are painful sensations in the muscles, headache, which are often combined with hearing loss, vomiting, and nausea.

What to do if your back hurts after spinal anesthesia. Post-puncture pain syndrome occurs within 12-48 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 predominant localization in the occipital and frontal zones.

How often can spinal anesthesia be done?

Repeated anesthesia is recommended after the overgrowth of the defect of the spinal membrane. But there are exceptions. If repeated surgical intervention is necessary, secondary spinal anesthesia is allowed, but not before the complete absorption of the drug from the composition of 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 an injection is made during the operation in 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 affordable method of blocking pain impulses, without any special advantages, but also obvious disadvantages. Successful lumbar anesthesia can be subject to a high level of equipment of the clinic and the qualifications of a specialist.

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

Features of the procedure

When anesthesia is used, the nerves that conduct pain are switched off. This requires the administration of an anesthetic in close proximity to the nerves.

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

During the procedure, the patient should sit or be in the supine position. The choice of the position of the patient is carried out by the anesthesiologist. During the period of drug administration, the patient must be immobile. Before the introduction of the anesthetic substance, the patient's skin is treated. For this purpose, special disinfectant solutions are used.

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

Despite the ease of implementation, spinal anesthesia should only be performed by a specialist.

Scope 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 due to the fact that when a person is conscious during such operations, his psyche may suffer. Spinal anesthesia is widely used in surgery due to the presence of a large number of advantages:

During the application of the method, there is a significant decrease in pain sensitivity in the groin and legs.
Spinal anesthesia is allowed for patients who are diagnosed with acute or chronic pulmonary diseases.
With the help of this method, a significant decrease in muscle tone in the acute intestine is carried out if an operation is performed on this organ.
Spinal anesthesia eliminates the possibility of suffocation in patients.
During the period of using 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, due to the relaxation of the walls of blood vessels.
Spinal anesthesia is widely used for caesarean section when there is a need for a quick birth of a child. This procedure is safe and is characterized by minimal impact on the health of the baby. With a high pain threshold in a patient, spinal anesthesia may not be effective enough. In this case, general anesthesia is used.

Spinal anesthesia is quite effective and is characterized by the presence of 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, which can lead to certain consequences.

When the body is dehydrated, this method of anesthesia is not recommended for patients. 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.
With an increase in intracranial pressure, the use of spinal anesthesia is strictly prohibited.
It is not recommended in the presence of allergic reactions to the means necessary for its implementation.
If the patient has diseases of the spinal column, then this method is not recommended.
If there is a skin rash at the injection site, anesthesia is not used.
In the process of childbirth, in some cases, the use of spinal anesthesia is prohibited. If there is fetal hypoxia or malformations of its development, 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, which must first be taken into account. Otherwise, the patient may experience undesirable consequences.

Consequences and complications

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

Headaches. The appearance of pain in the head after spinal anesthesia indicates a decrease in CSF pressure. Also, this pathological condition can occur against the background of irritation of the meninges. These side effects occur in 10 percent of anesthesia cases.
Interosseous ligamentosis. When anesthesia is used, patients may experience severe back pain. They are observed not only at the site of the puncture, but also in the area of the entire spinal column. This complication occurs due to traumatic manipulations, repeated puncture, aseptic inflammation. If there is pain in the back after anesthesia, treatment is not carried out. These negative symptoms will go away on their own within a few weeks. With the duration of the pain syndrome, darsonvalization of the puncture site is carried out. Also quite effective in this case is electrophoresis using magnesium. Back pain can also be observed after general anesthesia is applied.
Spinal cord or nerve injury. These symptoms most often occur after the use of anesthesia. The cause of the injury may be the puncture itself. As a result, neurological complications often occur. During the procedure, patients complain of the appearance 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 an infusion support before surgery, anesthetic drugs must be injected into the subarachnoid region. In this case, dangerous hemodynamic disturbances will not occur. With the development of severe hypotension in the elderly, intravenous administration of sodium chloride is carried out for several minutes. The dosage of the drug is determined by the doctor. Usually it is from 3 to 3.5 milliliters per kilogram of a person's 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 a correction with adrenomimetic and colloidal drugs.
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. In order to avoid the occurrence of respiratory depression, it is necessary to strictly observe the dosage of the drug, which is administered in the patient's sitting position. To eliminate the unwanted effects of the administration of narcotic drugs, the use of Naloxone is recommended.
Prolonged headaches after surgery. The use of this anesthesia for cesarean section quite often causes migraine or severe headache. In most cases, side effects are observed in young women who are of low weight. Also, a pathological condition can occur with a variety of endocrine diseases. The onset 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 without fail. When a complication occurs, in most cases, patients complain of loss of sensitivity in intimate areas, urinary incontinence, paresis of the legs of varying severity. The appearance of a pathological condition is observed after a few days after surgery. Symptoms resolve on their own after 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 due to the fact that the pressure in the inner ear and cerebrospinal fluid pressure is 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 macnipulation, there may be signs of aseptic meningitis in the form of headache, stiffness of the neck muscles, photophobia, hyperemia. These symptoms are observed in the patient for a week. With immobility of the patient's neck, in most cases it is possible to judge aseptic meningitis.
Adhesive arachnoiditis. It is a rather serious complication. When it appears on the background of vertebral anesthesia, the use of surgical intervention is required. With its help, the symptoms and manifestations of the disease are stopped. 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 is observed 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 fully restored.
Soreness 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 the introduction of anesthesia in rare cases, cardiac arrest is observed. This is a serious complication that requires immediate medical attention. Otherwise, there will be a lethal outcome of a person. Many patients complain that after the introduction of anesthesia, their hair begins to fall out. This procedure can lead to vision problems that can lead to a scotoma.

Spinal anesthesia is the method of choice for many surgical interventions below the navel. This type of pain relief is best suited for older people with chronic obstructive pulmonary disease, endocrine, kidney disorders.

Indications for SA:

Operation below the level of the navel;

Surgical intervention on the perineum;

C-section;

Operations on the lower extremities, except for amputation;

Gynecological and urological operations.

Contraindications:

Patient refusal;

blood clotting disorder;

Infection at the puncture site;

Violation of the conduction of the heart;

Peripheral neuropathy;

Multiple sclerosis;

Spinal deformity;

Sepsis, meningitis.

Spinal anesthesia: preparation for the procedure

Preparation consists in talking with the patient and obtaining consent for the procedure. Premedication is carried out immediately before anesthesia.

Spiral Blockade Kit:

Spinal needle with guide (introducer);

Syringe for anesthesia of the puncture site;

Syringe for intrathecal anesthesia;

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

Anesthetic ("Markain", "Bupivacaine", "Lidocaine").

Spinal Anesthesia: Patient Position

There are two main provisions:

Lying on my side. The position is used most often in anesthesiology practice. The patient should be bent as far as he can, with the knees pressed against the torso and the chin against the 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, the legs should be placed on the 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

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 proposed injection for superficial anesthesia. Next, a needle for neuraxial anesthesia is punctured and advanced along the midline to the spine. Advance until the assistant feels a failure, after removal of the introducer, cerebrospinal fluid should appear. As quickly as possible, an anesthetic syringe is attached to the needle, which is slowly injected into the spinal cord. After the anesthetic is injected, the needle together with the syringe is taken away and a sterile gauze bandage is applied at the puncture site, fixing it with a plaster.

spinal anesthesia. Complications:

Arterial hypotension and decrease in heart rate (bradycardia);

Respiratory disorders (apnea);

epidural abscess, meningitis;

Traumatic injury of the spinal cord;

epidural hematoma;

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

Ischemic disorders occur when adrenaline is used as an adjuvant;

Post-puncture syndrome.

Spinal anesthesia: consequences

A frequent long-term consequence of intrathecal anesthesia is post-puncture headache. The reason is the outflow 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, dizziness. In order to prevent such phenomena, the operator should use fine needles 25-27 G for neuraxial anesthesia. In the event of such effects of anesthesia, immediate treatment begins. It consists in constant bed rest, infusion therapy in a volume of up to two liters per day, heavy drinking, the use of caffeine and non-steroidal anti-inflammatory drugs. The headache may last 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 carried out in modern medicine under anesthesia. The type of anesthesia is determined by the type, duration of the operation, 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 sensitivity.

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

Description

If during the 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 lies in the introduction of an anesthetic into a certain area near the spinal cord (in the back - therefore, this method began 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 - 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 anesthetized. The anesthesiologist should pass the needle to the spine, ligaments between the vertebrae, the epidural region and the meninges, then inject the selected anesthetic.

There are numerous reviews of caesarean section with spinal anesthesia.

Spinal anesthesia technique

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

Spinal anesthesia has the following technique: anesthesia is applied to the spine in this position: the patient is sitting (it is necessary to bend the back, press the chin to the chest, bend the arms at the elbows) or lie on the side. A sitting position is preferable, the spinal region is better visible. Complete immobility is required to avoid complications during spinal anesthesia. Before performing anesthesia in the back, the specialist will palpate the optimal site for the injection (this is the area between the third, fourth and fifth vertebrae).

To prevent infection or blood poisoning, the place 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 differs in its length (about thirteen centimeters) and small diameter (about one millimeter), so local anesthesia is not done in some cases. The needle is inserted very slowly, overcoming all skin layers, the epidermis layer, the solid membrane. The trajectory of the needle stops at the entrance to the subarachnoid cavity, a mandrin is pulled out of it (that is, a conductor that closes its lumen). If the action is performed correctly, then the cerebrospinal fluid flows out of the needle cannula; an anesthetic is injected, the needle is removed, the injection site is covered with sterile materials.

Immediately after using the medicine, a person may feel a side effect: tingling in the legs, heat spill (it will last for some more time - the natural effect of anesthesia). Unlike epidural, perfect anesthesia with spinal cord anesthesia comes in ten minutes, the type of drug determines the time of functioning of anesthesia, depends on the duration of the intervention.

Means for spinal anesthesia

Spinal anesthesia is carried out with the help of 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 the tenth degree of block for 30-45 minutes. "Procaine" is a medicine with a short period of action. 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 (starting from five milligrams and more) can be used.

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

Adjuvants: epinephrine (prolongs the 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 a baby from the need to anesthetize the patient. Spinal anesthesia for caesarean section eliminates the possibility of the drug affecting the child. For the first time in caesarean section, spinal anesthesia was used by Kreis 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

An injection is given under neuraxial anesthesia for a single one (what is the main difference from the epidural technique, in which a catheter is inserted to inject the drug). Contraindications to the use of this method are as follows: a reduced level of platelets in the blood, poor blood clotting, heart rhythm disturbances, infectious processes in the area of drug administration. Recovery is fast. Differences and the main advantage, when compared with general anesthesia, is an extremely low probability of dangerous complications for the mother and child, relatively small blood loss.

Feedback on 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 the elimination of pain during labor, the creation of safety and comfort for the child and the woman in labor. The drug is injected into the lumbar region, suppressing pain. At the same time, the time is calculated in such a way that the effect of the remedy decreases by the period of attempts, the only exception is a high degree of myopia in a woman and heart defects. Lumbar anesthesia is desirable to do:

if a woman is not psychologically ready for childbirth;
if a large fruit;
at the birth of the first child;
with premature birth;
for stimulation: when there is no labor activity after the amniotic fluid has passed.

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 a variety of 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;
unstable mood of the patient (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 surgery;
hypoxia, pathologies of the central nervous system.

Absolute contraindications for this type of anesthesia are:

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