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Concept
Spinal anaesthesia
Summary
Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually long. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true analgesia, motor, sensory and autonomic (sympathetic) blockade.
Administering analgesics (opioid, alpha2-adrenoreceptor agonist) in the cerebrospinal fluid without a local anaesthetic produces locoregional analgesia: markedly reduced pain sensation (incomplete analgesia), some autonomic blockade (parasympathetic plexi), but no sensory or motor block.
Locoregional analgesia, due to mainly the absence of motor and sympathetic block may be preferred over locoregional anaesthesia in some postoperative care settings.
The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available (Whitacre, Sprotte, Gertie Marx and others).
Spinal anaesthesia is a commonly used technique, either on its own or in combination with sedation or general anaesthesia. It is most commonly used for surgeries below the umbilicus, however recently its uses have extended to some surgeries above the umbilicus as well as for postoperative analgesia. Procedures which use spinal anesthesia include:
Orthopaedic surgery on the pelvis, hip, femur, knee, tibia, and ankle, including arthroplasty and joint replacement
Vascular surgery on the legs
Endovascular aortic aneurysm repair
Hernia (inguinal or epigastric)
Haemorrhoidectomy
Nephrectomy and cystectomy in combination with general anaesthesia
Transurethral resection of the prostate and transurethral resection of bladder tumours
Hysterectomy in different techniques used
Caesarean sections
Pain management during vaginal birth and delivery
Urology cases
Examinations under anaesthesia
Spinal anaesthesia is the technique of choice for Caesarean section as it avoids a general anaesthetic and the risk of failed intubation (which is probably a lot lower than the widely quoted 1 in 250 in pregnant women).
Official source
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