View an animated version of this procedure:


Definition

Spinal and epidural anesthesia are ways to numb surgical patients from the chest on down the legs. Both spinal and epidural anesthesia involve placing medications directly into the spinal area.

Epidural Injection

nucleus factsheet image

© 2008 Nucleus Medical Art, Inc.


Parts of the Body Involved

The anesthesia is applied to your back and spine.


Reasons for Procedure

Spinal and epidural anesthesia is frequently given for surgeries involving the pelvis, hips, and legs, as well as childbirth. Advantages of spinal and epidural anesthesia include the ability to be awake during the operation and the ability to avoid complications of general anesthesia. Some research suggests that patients who receive spinal or epidural anesthesia lose less blood during surgery and have better pain control after surgery.


Risk Factors for Complications During the Procedure

  • Bleeding disorders
  • Prior bad or allergic reactions to anesthetics
  • Dehydration
  • Immune system disorders

What to Expect

Prior to Procedure

Always make sure that your healthcare provider is aware of:

  • Your drug allergies
  • The medications you are taking
  • Any heart or lung conditions you have
  • Any previous reactions that you or other family members have had to anesthesia
  • Any bleeding problems you have had in the past

An intravenous line may be placed in your arm because spinal and epidural anesthesia can cause low blood pressure. Keeping your fluid levels will help keep your blood pressure up during the procedure. You’ll also be connected to various monitors to keep track of your blood pressure, pulse, and the oxygen content of your blood. Depending on how long the surgery will take, you may have a catheter put into your bladder to keep your urine drained.

Description of the Procedure

Prior to receiving spinal or epidural anesthesia, the area of your back where the medicine is injected will be cleaned with a disinfectant solution. You may be given an injection of local anesthetic directly over the spot where the spinal or epidural anesthetic will be given, to decrease pain from the amesthetic needle.

Spinal anesthesia involves a single injection of medication into the sac of fluid that surrounds your spinal cord.

Epidural anesthesia may be given as a single injection just outside of the sac of fluid that surrounds your spinal cord. When more than one dose of epidural anesthesia might be required, the anesthetist will leave a tiny, flexible tube or catheter in place outside of the fluid sac surrounding your spinal cord. This way more anesthetic can be given easily if the operation takes longer than expected. Some surgical centers leave the epidural tube in place for 24 hours or more after surgery, using it to administer pain medications during the immediate postsurgical period.

After the injection of spinal or epidural anesthesia has been completed, or after the epidural catheter has been removed, a small bandage will be placed over the area where the needle was withdrawn.

After Procedure

After spinal anesthesia, you’ll be kept in bed with your head flat for several hours. This is to prevent you from developing a headache.

After either spinal or epidural anesthesia, you’ll be kept in bed until your legs are no longer numb and it’s considered safe for you to walk.

How Long Will It Take?

  • Spinal anesthesia begins working nearly immediately after the injection is completed.
  • Epidural anesthesia takes about 10 to 20 minutes to begin working.

Will It Hurt?

Needle insertion for either spinal or epidural anesthesia may be painful. The operation (or contractions during childbirth) should not hurt after receiving spinal or epidural anesthesia; you may, however, still feel pressure or tugging.

Possible Complications

  • Severe headache
  • Drop in blood pressure
  • Nerve damage
  • Infection
  • Allergic reaction to the anesthetic used
  • Seizures
  • Heart attack

Average Hospital Stay

Hospital stay will depend on the type of surgery being performed.

Postoperative Care

At the Hospital

While you are recovering in the hospital, you will receive the following care:

  • If you’ve received epidural anesthesia, and you need pain medicine after surgery, the epidural catheter may be left in place in order to continue supplying small doses of numbing anesthesia.
  • When you no longer require pain control, the epidural catheter will be removed.
  • If you have spinal anesthesia, you’ll be kept lying flat for a number of hours so that you don’t develop a headache.
  • If you have had epidural or spinal anesthesia, you’ll be kept in bed until you have sufficient feeling in your legs again to walk safely.

At Home

When you return home after the procedure, do the following to ensure a smooth recovery:

  • Do not drive or operate machinery for at least 24 hours after having received anesthesia
  • Do not drink alcohol for at least 24 hours after receiving anesthesia

Outcome

Spinal and epidural anesthesia should numb you so that you don’t feel pain during the course of your operation.


Call Your Doctor If Any of the Following Occurs

It is important for you to watch your recovery once you leave the hospital. That way you can alert your doctor to any problems. Call your doctor immediately if any of the following occur:

  • Fever
  • Persistent or severe headache
  • Dizziness, fainting
  • Weakness, numbness, or tingling in your arms or legs
  • Skin rash
  • Difficulty breathing