The lowly spinal anesthetic
Jul 28th, 2007 by Terry
One of the most widely misunderstood and underappreciated modes of anesthesia deserves mention here - the spinal anesthetic.
By injecting between 1 and 3 ml of local anesthetic directly into the spinal fluid, a profound, time-limited block of sensation and mobility can be achieved. This is a very useful way to provide the surgeon a way to operate without me having to put YOU into a deep sleep.
I field questions all the time from patients about how dangerous spinal anesthesia is, how their best friend’s cousin’s sister had a spinal and has had back troubles ever since, how a spinal anesthetic will leave you permanently paralyzed, how it really hurts going in. More than one patient has expressed the fear to me that they did not want to be awake and have to watch their operation.
Well, I know that just the thought of somebody putting a needle in my back makes me cringe, and I put needles in people’s backs for a living. So, believe me, your fears are not something your anesthetist takes lightly.
But let’s take a closer look at your wide-eyed lack of enthusiasm misgivings about getting a spinal. First, let’s say YOU need an operation, and spinal anesthesia has been offered to you as an option.
We’ve come a long way since the first spinal anesthetic was administered in 1898, when two physicians injected cocaine into each others’ backs! The stuff we use today has predictable actions and durations, and minimal to no side effects.
All spinals are inserted after putting a little numbing medicine into your skin on your back. After that, you should generally just feel gentle pushing and pressure. You really won’t mind your anesthetist working on your back because at this point you’ll be feeling pretty loopy from the sedation you’ve just been administered. The amount of spinal medication you are given is based on the length of time your surgeon needs for the surgery, and is dosed accordingly. After the spinal is in, your legs will start to feel warm and heavy; soon you will be able to move them less and less. Within 5 minutes, YOU will feel nothing from well above your site of surgery all the way down to where your toes should be but you can’t feel them either.
Your surgeon can now have his way with you, but YOU could care less, because you will feel nothing and your mind will be blissfully sedated. Ah, but if only we could all feel this way all the time - world peace!
And then your surgery is over and your spinal wears off and is gone forever. That’s a good thing. And a bad thing too, since when the anesthesia wears off, the pain steps in. Your doc will have you covered for that, so be sure to ask for your pain medication if you are in discomfort.
You do not become paralyzed from your spinal, and you will not develop back problems from it. No anesthesia is without risk, but YOU are taking bigger chances getting into your car everyday or crossing the street at a busy intersection.
Added benefits of choosing a spinal anesthetic:
- you will breathe on your own throughout the operation.
- you will avoid the possibility of a dry sore throat from a breathing tube.
- you will highly lessen the possibility of post-op nausea and vomiting.
- you will be quite awake by the time your spinal wears off. No possibility of hangover.
- you have more control over how sleepy you actually want to be during the operation. Control-freaks alert: you can be wide awake during the operation if you so desire.
Next time you need surgery (but may you never need it) and your anesthesia provider offers you the spinal option, just say yes.
I ended up with a spinal for both of my C-sections….
I too had misgivings about needles in my back. What I tell people now that I just needed to hear is:
Anesthesia-ologists pretty much do this all day and know what they are poking into… The schooling couldn’t of hurt either.
I loved my Anesthesia-ologists
Nurse anesthetists also insert spinal and epidural blocks. In fact, 2/3 of all anesthetics in the country are delivered by CRNAs (certified registered nurse anesthetists). Just wanted to clarify that. You can read more about nurse anesthetists here: http://www.aana.com/aboutaana.aspx?ucNavMenu_TSMenuTargetID=179&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=265
I had a spinal for a c-section with no complications, so I’m not fear-mongering. But to say that all you’ll feel is “gentle pushing and pressure”–I don’t think so! My anesthesiologist told me it would feel like a bee sting. Then, right as he put the needle in, he added, “from an 800-lb bee.” He wasn’t joking.
About 10 years ago I fell and fractured my ankle in several places… long story made short- I needed an ORIF and now have some lovely titanium additions to my “original equipment”. I had several surgical procedures in the past and always hated the after effects of general anesthesia…. the vomiting, sore throat, etc. So, when the anesthesiologist offered a spinal instead- and thoroughly explained it.. I was THRILLED…. ( I would have said I jumped for joy.. but I wasn’t even walking just then…lolol). It was a spectacularly positive experience! Your decriptions of the actual experience and the post-op transition was right on. Unlike the previous poster - I barely felt anything when the anesthesiologist inserted the needle/ catheter. Hopefully I will not need any further surgery - but if I do - and spinal anesthesia is an option… I will certainly take it!
My biggest fear would be infection.
Sterilize me until I scream!
Bonafide and legitimate fear, beajerry - I neglected to include in the article that we prep your back with a disinfectant solution first and foremost before we even begin to consider touching you in any other way! Thanks for inadvertantly pointing that out!
Hello!!!!
I really love your spot!!!!
I’am a Portuguese Nurse Anesthesia, and my dream is to become a CRNA! I really love your job!!!!
Congratulations for the blog!
I will put your blog into my favourites in my spot!
Best regards
hey
its very point of view.
Nice post.
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thx