Anesthesia in the spine: options, advantages and disadvantages

Spinal anesthesia

Caudal, epidural and spinal anesthesia belong to the so-called neuroaxial or central blockade, which by local anesthesia affects the spinal cord and its roots.

The most common technique is spinal anesthesia, which is used, in the case of surgery for hernia repair, urological and gynecological operations.

In this article, we will consider what is spinal anesthesia, the technique of performing surgical manipulation, and also determine the contraindications and consequences of spinal anesthesia.

Effects of anesthesia on the spine

The spinal cord, located in the vertebral canal, is one of the most important segmental elements of the central nervous system.

Inside the organ, terminating at the L2 level of the vertebra, is the lumbar spinal fluid into which special pharmacological drugs for spinal anesthesia are injected.

A local anesthetic, for example, Naropin, introduced into the spinal cord, mixing with the liquid content, causes the blockage of nerve roots within the spinal space. In other words, spinal anesthesia begins to act.

1. Initially, dorsal anesthesia acts on preganglionic symptomatic fibers that are located between the thoracic and lumbar spine. Purpose: to expand the vessels. Side effects: a drop in blood pressure and a temperature rise in the dermis.
2. The next target of anesthetic is fibers of temperature sensitivity. There is a cooling, and then a thermal effect.
3. The third stage of the anesthesia is the fibers of epicritic pain. Naropin provokes a protopathic pain syndrome.
4. The final stage of the action of anesthesia is the blocking of the innervation of internal anatomical organs, at which their surface, deep, vibrational and proprioceptive sensitivity.

So, it looks like the action, and the technique of conducting an anesthetic drug in the spinal canal of the spinal column.

Frequently asked questions before and after surgery:

1. It is painful to do spinal puncture (anesthesia) - modern pharmacological drugs can provide a complete blockage of the sensitivity of system organs of life.
2. What is the cost of regional anesthesia - it all depends on the degree of complexity of the clinical pathology, the location of surgical intervention and the qualification of a specialist.
3. Can back ache after surgery - the back should be sick for 2-3 days, as the nerve endings return their reflex sensitivity.
4. What is better is "spinal cord" or general anesthesia - the choice between spinal topographic anesthesia and general anesthesia is determined by a number of medical indications.

What to do if your head hurts after spinal anesthesia - you will find the answer to this question after reading this article.

Contraindications and preoperative preparation

Local spinal anesthesia is carried out below the thoracic diaphragm, and only if there are objective reasons that exclude general anesthesia.

Relative contraindications for the surgical intervention include:

• heart failure and ischemia of the heart;
• hypersensitivity of the nervous system;
• headache;
• septic conditions;
• hypovolemia;
• cachexia.

Absolute contraindications to spinal anesthesia:

• mental illness;
• inflammatory pathology in the zone of the lumbosacral spine; correlated hypovolemia;
• suppurative skin diseases in the lumbar region;
• severe form of anemia;
• pronounced kyphosis, scoliosis and other abnormal conditions of the spine; nutritional hypertension;
• an allergic reaction to local anesthetics.

In addition, spinal anesthesia is not recommended for people with chronic diseases cardiovascular system, patients with diabetes, patients over 65 years of age, and people with hypertensive pathology.

Before the operation begins, psychogenic preparation of the patient is necessary.

Half an hour before the surgery to stop pain in the back, the person intramuscularly injected with narcotic, antihistamine and sedative pharmacological agents.

Typically, a hypodermic injection in the back is a 20% caffeine solution, and a 5% solution of dihydroergotamine, which increases venous return in the blood vessels.

Surgery Technique

The spinal puncture to the patient is made in a sitting or lying position on the side, so that the knees are as much as possible pressed to the chest. Before the spinal needle is inserted, the skin of the back is treated twice with an antiseptic or alcohol.

It is not recommended to use iodine solution, since it can get into the subarachnoid space, and cause aseptic arachnoiditis. After anesthetizing the puncture site, with the reaction lack of sensitivity, a 5% solution of novocaine is injected.

Spinal needles for spinal puncture are selected individually.

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After puncturing the yellow spinal cord, the mandrone is removed, and further movement of the needle is brought to the piercing of the hard cerebrospinal membrane, for the purpose of insertion into the cavity canal the spine.

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The flow of liquor from the pavilion of the needle is a sign of an exact hit in the subarachnoid space. At the discretion of the surgeon, the anesthetic (Naropin) can also be delivered in a paramedian way. However, there is a risk of getting the needle into the abdominal area at the slightest deviation from the trajectory.

Postoperative period

After surgery with the use of spinal puncture, various deterioration of the general condition of the patient is possible. First of all, it is a headache after spinal anesthesia.

This condition is considered normal, since the local anesthetic (Naropin) has a residual effect. The patient should not panic, that after anesthesia the head hurts.

Within 4-5 hours after the operation, under condition of normalization of arterial pressure, and at rest, the headache disappears. The next complaint of the patient is that his back hurts after spinal anesthesia.

However, after spinal anesthesia, they restore their previous sensitivity, which is the cause of pain in the back. As a rule, the patient under this condition is administered anesthetic pharmaco-components. Other complications of spinal anesthesia include:

• Spinal hematoma.
• Decrease or increase in arterial and intracranial pressure.
• Nausea and vomiting reflex.
• Decrease in frequency reductions of the heart (arrhythmia).

Any feelings of discomfort and painful sensations should be notified to the attendant medical staff.

Spinal anesthesia (CA) in obstetric practice

Currently, the method of CA is very often used for obstetric care. Local anesthesia during childbirth has a number of advantages, in comparison with general anesthesia in the operation of cesarean section.

Spinal anesthesia with caesarean section is devoid of such unpleasant complications as aspiration of gastric contents, intubation difficulties in the trachea, etc.

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An important indicator is that with a spinal anesthesia in a caesarean section, the risk of death will significantly lower the risk factor than with regional and / or general anesthesia.

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In addition, after cesarean section under CA, newborns (Apgar scale) are less susceptible to respiratory depression.

Future moms may have a question, is anesthesia dangerous in the spine during surgery? The consequences, complications and further postoperative treatment completely depend on the individual physiological characteristics of the mother and the qualifications of the serving medical staff. What are the pitfalls you can expect in the postoperative period? First of all, do not be afraid for the health of the child. Any qualified specialist will perform surgery as high as possible without compromising the health of the baby. As for the female body, the health workers are ready to "meet" with the following problems:

• Minimize the risk of infection by observing strict asepsis rules.
• The resulting severe headaches after spinal anesthesia are the result of a decrease in the tone of smooth muscles in the walls of the blood vessels leading to a deterioration of the blood supply. In this case, therapeutic treatment is suggested that increases or lowers blood pressure. How long the post-puncture headache will last depends on the physiology and the concomitant clinical conditions of the patient.
• Since the vegetative nerve fibers of the lumbosacral zone are restored last, patients complain of a delay in urination. However, with a crowded and painfully stretched bladder, appropriate treatment is required - catheterization.

Of particular danger is the so-called total spinal block, the treatment of which requires the maximum attention and concentration of specialists. Pathology occurs as a result of an incorrect intererateal administration of an anesthetic.

The patient has a loss of sensitivity or weakness in the hands and feet, there is difficulty breathing and even possible loss of consciousness. It is worth at least some delay and not to start resuscitation in time, a person is expected to die.

Algorithm of medical actions of the first aid at a total spinal block:

• Resuscitative measures of the cardiopulmonary system.
• Artificial ventilation of lungs is 100% oxygenated.
• Immediate introduction of an intravenous infusion load to avoid cardiac arrest.
• Artificial ventilation is carried out until the problem is completely resolved.

Thus, summing up the results of everyday clinical practice, we can state that spinal anesthesia, as a kind of regional anesthesia, has both unconditional advantages, and certain shortcomings before general anesthesia in case of operative interference. It should be noted that regional anesthesia is a kind of medical art, which, unfortunately, not many anaesthesiologists are available. Therefore, a free choice of anesthetic should remain with the patient.

A source: https://MoiPozvonochnik.ru/otdely-pozvonochnika/pozvonochnik/spinalnaya-anesteziya

Spinal anesthesia: 7 side effects and sequelae (complications)

Spinal, it is spinal anesthesia, - a method of local anesthesia, used in operational interventions in the lower body segments (lower extremities, bladder, genitourinary and reproductive system).In everyday life this method is designated by the term "anesthesia in the spine which accurately reflects its essence. The procedure is carried out by injecting an anesthetic into the subarachnoid space.

Therefore, in some sources anesthesia in the back is called subarachnoid or lumbar. So, what is spinal anesthesia? What are its pros and cons? What indications for its application exist?

Types of anesthesia

Spinal anesthesia is only one of the types of local anesthesia. All of them are based on local blocking of nerve conduction and are not accompanied by disconnection of the patient's consciousness.

There are the following types of disabling pain sensitivity at the local level:

1. Application - the introduction of the drug is carried out transdermally (lubrication, spraying, the use of an adhesive plaster with an anesthetic).

   Used for dental anesthesia injection site, in ophthalmology, as well as before carrying out bronchial and gastroscopy.

2. Infiltration - the tissues are infiltrated layer by layer with anesthetic (creeping infiltration according to Vishnevsky).

   It is used for tissue anesthesia in small operations (with the exception of purulent and oncological).

3. Conductor - anesthetic is injected in the immediate vicinity of the nerve trunk.

Local conductor anesthesia also includes cerebrospinal (spinal) anesthesia.

The method allows you to block the front and back roots of the spinal cord, which leads to a loss of pain, thermal and tactile sensitivity, causes muscle relaxation. When performing anesthesia, the lumbar puncture is performed 15-20 minutes before the intervention begins.

What is the difference between spinal anesthesia and epidural?

Spinal anesthesia can be of two types: epidural and subarachnoid.

In the first case, the drug is injected into the epidural space located above the hard shell of the spinal cord.

The principle of action of this type of analgesia is the same as that of the spinal variety, however, the anesthetic penetrates into the spinal cord by perfusion.

With spinal (subaranoid) anesthesia, the anesthetist inserts the needle directly under the subarachnoid sheath, where the spinal cord is located.

Lumbar version of anesthesia allows quick and strong blocking of sensitivity, but it is associated with a high risk of complications.

Drugs for spinal anesthesia

Drugs for spinal anesthesia do not differ from those used for other types of local anesthesia.

Among the most popular anesthetics are:

1. Lidocaine - the 5% solution used disables the pain sensitivity for 1-1.5 hours. The volume of the drug for a patient weighing 70 kg and an increase of 165-175 cm is 1.2 ml. The dose is increased if the body weight of the patient differs from the nominal by more than 10 kg, and the height - by 15 cm. The drug slows the heartbeat, so it can not be used to anesthetize people suffering from bradycardia.
2. Tetracaine 0.5% medicine for spinal anesthesia. Causes loss of sensitivity for up to 3 hours. The dose for the patient with the parameters specified in the previous paragraph is 2.4 ml.
3. Omnikain is one of the strongest, however, toxicest anesthetics for spinal anesthesia. Used 0.5% solution, the duration of which is up to 4 hours, is administered in a dose of 3 ml.

To enhance and prolong the effect, preparations for spinal anesthesia are mixed with epinephrine (0.2 ml 0.1% solution) or mezaton (0.2 ml of 1% solution).

This allows you to increase the time of anesthesia by half, which often eliminates the need for repeated injections.

Add vasoconstrictors just before and during injection.

Technique of spinal anesthesia

Preparation for spinal anesthesia is carried out immediately before the procedure.

The doctor selects the needle to administer the agent, correctly places or seats the patient, prepares the necessary solutions.

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The classical technique of spinal anesthesia involves spinal needles with a diameter of 22-25 G. Thicker needles are elastic and easily carried into the necessary area.

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In doing so, they damage a large number of fibers of the meninges, which subsequently causes headaches. Thin needles require the use of a conductor, but can reduce the risk of postoperative headaches.

Modern spinal needles have a sharpening resembling the tip of a pencil. Because of this, they do not cut, but push apart the fibers of the meninges.Headaches after this occur extremely rarely. The number of such cases tends to zero.There is a

May depend on what and how spinal anesthesia do, with how often the complications of this type of anesthesia develop.

During the procedure, the patient sits or lies in a bent position.

Lying posture is used to provide low access in gynecological and urological clinics, as well as for anesthetizing patients with obesity.

Puncture is performed at the level of L3-L4 L2-L3 vertebrae. The site of the injection is treated with alcohol, iodine and again with alcohol, after which it is carefully drained with sterile napkins.

Conduct local infiltration anesthesia, after which a puncture needle is inserted. Passage into subdural space is carried out through an interconnected binder.

Evidence of a fall is a sense of failure and aspiration into the liquor syringe.

Before the final administration of the drug, a test dose is administered, after which the patient's condition is carefully monitored for 2-3 minutes. With normal saturation, heart rate, blood pressure, and BHP, the remaining volume of the drug is administered.

Advantages and disadvantages of spinal cord anesthesia

Like any other invasive method of treatment, anesthesia in the spine during the operation has its advantages and disadvantages.

Among the advantages are:

• simplicity of implementation compared with the introduction of general anesthesia;
• small risk of complications of spinal anesthesia after surgery;
• the patient's ability to stay in consciousness;
• ease of monitoring the patient's condition;
• high rate of onset of analgesic action.

The disadvantages of lumbar anesthesia are quite small. B and list includes time-limited (the time of the operation depends on how much spinal anesthesia departs), uncontrolled effect (the effect of anesthetic can not be canceled) and the inability to use the technique for anesthetizing the upper departments of the body.The latter is due to the fact that local spinal anesthesia in women is used mainly in gynecology and obstetrics. For men, spinal anesthesia is the main way of anesthetizing with urologic surgeries.

Indications for spinal anesthesia

Indications for the use of spinal anesthesia are all surgical interventions, in which the surgeon operates below the L2 line of the vertebra.

As a rule, this method of anesthesia is used for large surgical interventions of the gynecological, urological, traumatological profile.

Subarachnoidal administration of an anesthetic in labor is justified only at the extremely low pain threshold of the mother in childbirth, as well as in the transition to cesarean section.

With the rapid expulsion of the fetus, anesthesia introduced into the spine is used only until the newborn is removed.

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Before sanation of the uterus cavity and suturing, the woman's consciousness is disconnected by using intravenous anesthetic drugs (sodium thiopental, propofol).

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Ventilation of the lungs is carried out with the help of a non-invasive method (through a mask).

Contraindications

Contraindications to spinal anesthesia may be absolute or relative.

Their absolute variety completely excludes the possibility of anesthesia by the method in question.

If there are relative contraindications, the intra-vertebral method of anesthesia is possible if the benefit to the patient exceeds the risks.

Absolute

From subarachnoidal analgesia, they refuse if there are absolute contraindications, since anesthetics can cause severe postoperative complications. Contraindications to the spinal version of anesthesia, completely excluding the possibility of it, include in their list:

• lack of patient consent;
• infectious processes in the area of ​​the alleged anesthetic injection in the back;
• sepsis;
• coagulopathy;
• high intracranial pressure;
• allergic reactions to anesthetics in the anamnesis.

In the presence of absolute contraindications, the operation is performed under general anesthesia or, if possible, under local infiltration anesthesia.

Relative

Spinal anesthesia is relatively contraindicated when:

• The presence of a skin infection near the injection site;
• hypovolemia;
• back pain;
• decreased blood clotting;
• diseases of the central nervous system;
• mental disorders in the patient (without prior medical suppression of consciousness).

Complications and side effects

Side effects and complications after spinal anesthesia can develop as soon after the introduction of anesthetic, and after some time after the end of the operation.

From the point of view of immediate complications, spinal anesthesia is dangerous:

• the risk of developing dyspnea or apnea - a complication occurs when the anesthetic is administered excessively, which leads to the blocking of the zones responsible for the work of the respiratory musculature. The problem is solved by using artificial ventilation until the spontaneous respiration (the time of action of the anesthetic) is restored.
• Paresthesias - arise as a result of irritation of nerve endings during the introduction of the needle. Pass by yourself, medical intervention is not required.
• Nausea or vomiting - the problem appears as a result of hypotension, which occurs when the vagus nerve is irritated. Normalize the patient's condition with the help of drugs that increase blood pressure.

As a rule, there are no other risks of regional anesthesia.After the action of the anesthetic is over, the patient may experience such anecdotal side effects as:

• Headache;
• Retention of urine;
• Meningitis;
• Arachnoiditis;
• Infectious processes;
• Neurological disorders;
• Back pain.

Most complications are eliminated by conservative treatment. Patients with headaches are assigned bed rest, infusion of saline solutions is performed, caffeine is administered.

Such people can get up only when the consequences of spinal anesthesia completely disappear.

Lumbar anesthesia is an excellent method of anesthesia, considered one of the safest. Complications after spinal anesthesia are rare and in most cases are successfully cured.

- epidural and spinal anesthesia

A source: https://SkeletOpora.ru/poleznoe/spinalnaya-anesteziya

Spinal anesthesia (spinal anesthesia): after effects, pain

Spinal anesthesia is one of the most commonly used methods of anesthesia for an operation in the lower part of the trunk.

It can be said that cerebrospinal anesthesia itself is a kind of operation, since it implies the introduction of anesthetic substances through a special needle in the spinal column.

Many patients are afraid of this method of anesthesia because of possible side effects. Fortunately, complications after spinal anesthesia are relatively rare and usually occur. And they pass usually themselves, not demanding any treatment.

What is spinal anesthesia?

What is spinal anesthesia?

Spinal anesthesia

Elimination of pain is provided by blocking the patency of impulses in the region of the roots of the nerve plexuses of the spinal cord.

The technique of spinal anesthesia may seem very complicated and unsafe, but in practice The probability of dangerous consequences for such anesthesia technique is less than when using a general anesthesia.

The question of what is best: general anesthesia or local through lumbar puncture, is not worth it. Each technique is used in certain situations for which it is intended. But objectively spinal anesthesia is both safer and cheaper and has a smooth period of "withdrawal" from anesthesia.
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When is it applied?

The action of spinal anesthesia is quite powerful, and the procedure itself, although relatively safe, is not without possible complications.

Therefore, it should be used strictly according to indications, and, where possible, replaced with more simple and safe methods (for example, injection of a local anesthetic subcutaneously).

Area of ​​spinal and epidural anesthesia

Spinal anesthesia is done in the following situations:

1. The need for surgical intervention in organs located below the navel.
2. Conducting gynecological operations in women or urological manipulations for men.
3. The need to operate the lower extremities (for example, treatment of varicose veins or thrombophlebitis).
4. Surgery to the perineum.
5. Elimination of pain during delivery or caesarean section.
6. In the form of an alternative to other methods of anesthesia, if they are not suitable because of the contraindications available to a particular patient.

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Contraindications

Spinal anesthesia has a number of relative (usually temporary or those that can be ignored) and absolute (more often lifelong, can not be ignored) contraindications.

Spinal anesthesia is allowed during pregnancy

Absolute contraindications include:

• refusal of the patient from the procedure;
• lack of necessary conditions and / or equipment for monitoring the condition of the maternity organism, during anesthesia and subsequent surgical procedures;
• presence of coagulopathy, treatment with anticoagulants (indirect anticoagulants, low molecular weight heparin) during the last 10-12 hours;
• infectious processes in the area where the puncture should be performed;
• presence of intracranial pressure in the patient (hypertension);
• the patient has a complete AV-blockade of the heart, severe aortic stenosis and other serious heart diseases.

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Differences from epidural anesthesia

Spinal anesthesia resembles epidural anesthesia: procedures are conducted in one place. But, despite the general similarity, these two procedures have significant differences between themselves.

Needles for spinal anesthesia

What is the difference between epidural anesthesia and spinal anesthesia? The main differences are:

1. In both cases, virtually the same set for puncture is used, but in the case of spinal anesthesia a thinner needle is used for puncture.
2. The dose of anesthetic for spinal anesthesia is much less than in the case of epidural. In addition, the anesthetic is injected below the level of the spinal cord into the area containing the cerebrospinal fluid (cerebrospinal fluid).

It should also be taken into account that almost immediately after injection of the drug into the subdural space, a feeling of numbness below the injection is developed.
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Differences from general anesthesia

The main differences between spinal anesthesia and general anesthesia -less chance of complications after the procedure and more rapid recovery of well-being. Also, the requirements for conducting spinal anesthesia are less than for general.

There is no guarantee against complications of spinal anesthesia, but complications occur several times less with this technique than with general anesthesia (especially fatal complications). Restoration of the patient occurs more quickly, and he is already in the first day after the procedure can independently move around the ward.

Set for spinal anesthesia

This is possible in the case of general anesthesia, but more often patients who have undergone general anesthesia for the first day are "incompetent" and need a long sleep.

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In addition, after general anesthesia, nausea, depression and cognitive impairment often develop (temporary forgetfulness, inability to concentrate, apathy).

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The advantages and disadvantages of the method

Like any other medical procedure, spinal anesthesia has several advantages and disadvantages. At once it is necessary to notice that the advantages are much greater than the "misses" of the procedure.

Pros of spinal anesthesia:

• pain killer effect is achieved instantly;
• at anesthesia of the woman in labor during sorts or a cesarean section medicines do not act in an organism of the child;
• technique of carrying out the procedure is much simpler than in the case of epidural analgesia;
• there is no probability of development of problems with breathing (injected anesthetics do not affect the respiratory center);
• a much lower dosage of anesthetics is used than with epidural analgesia.

Scheme of spinal anesthesia

Minuses of spinal anesthesia:

• During the procedure, blood pressure may fall, and after it patients often complain that their legs and / or headaches are aching;
• the anesthetic effect is limited in time, since it is impossible to perform "refueling" during the operation (in contrast to the epidural technique);
• After the procedure, the back may be severely ill in the puncture area for several weeks.

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How is spinal anesthesia done?

How long and how do spinal anesthesia? You need to start from where exactly drugs are injected. Enter their doctor in the subarachnoid space of the spinal cord, since it is here that the nerve branches are localized, the blocking of which prevents pain.

In most cases a puncture puncture is done between 2 and 5 lumbar vertebrae. The preferred location is the space between the 2 and 3 vertebrae. The final choice of the puncture site is influenced by the patient's history, in particular the presence of spinal diseases, previous operations on it, or trauma.

Preparation for spinal anesthesia

How long does spinal anesthesia last? Usually this procedure takes no more than 15 minutes.
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What does the patient feel?

Does it hurt during spinal anesthesia? Frequent question of patients who are to this procedure. In fact, in most casesespecially painful sensations during the procedure the patient does not experience.

Possible slight discomfort, which quickly enough (within a few minutes) completely passes. After spinal anesthesia, a tingling sensation in the legs is felt.

Despite the fact that this is quite normal condition, tell your anesthesiologist about your feelings, even if you can easily tolerate them.

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After spinal anesthesia: well-being, sensations

After the procedure, various uncomfortable sensations are possible. A large number of patients complain that the first time the head or back hurts. As a rule, pains are moderate, and do not require the use of medications.

Needles for spinal anesthesia during pregnancy

When you can stand up to the patient - the observing doctor decides. Independent attempts to get pregnant are fraught with consequences, so when making such a decision, the patient must first ask permission from the doctor.

And for the future it is necessary to follow all the recommendations of the doctor, in order to avoid or minimize the risks of postoperative complications (associated with the operation itself and with anesthesia).
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Spinal anesthesia (video)

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Possible consequences

Usually spinal anesthesia passes fairly smoothly and without any complications. Nevertheless, there is a risk of side effects.

Most often the following undesirable phenomena are observed:

1. Head and back pains, pains in the lower limbs (the chance of development is about 1%). They usually go by themselves, without the need for medication.
2. The fall in blood pressure (the chance of development is about 1%). The effect is eliminated by the introduction of special preparations intravenously and abundant drink.
3. Delayed urination (chance of development - less than 1%). Does not require any treatment, it takes place within 24 hours on its own.
4. Neurological disorders (sensitivity disorders, numbness, muscle weakness or convulsions). Very rare (approximately, in 1% of cases) appear. The tactics of their treatment depends on the severity and certain nuances, so it is not possible to describe the tactics of action in advance.

A source: http://osankino.ru/operacii/spinalnaya-anesteziya-spinnomozgovaya.html

"ANCIENT IN SPIN OR OPERATION UNDER SPINAL ANESTHESIA

Modern anesthesia has made significant progress in the development of a variety of methods of anesthesia.

Along with methods of general anesthesia, methods of safer regional anesthesia are now widely introduced and used, among which spinal anesthesia is most common.

The essence of the methods of regional anesthesia is that painful impulse (that is, felt by the patient pain) is blocked not at the level of the central structures of the nociceptive pathway, but at the level of the conducting nervous trunks.

In simple terms, with general anesthesia, pain (and other sensations) is disconnected in the brain itself, and when usedspinal anesthesiapain is blocked at the level of those nerves that this pain in the brain conducts, than anesthesia is achieved (absence pain and other types of sensitivity) in those parts of the body where it is necessary to conduct operational intervention. It is important to note that when spinal anesthesia is performed, the spinal cord itself is not the point of application, the puncture is performed below places of its termination, and, consequently, it can not be damaged, and the term "spinal anesthesia" is not quite correct.

Anatomical basis of spinal anesthesia

In addition to the "targeted" action, regional anesthesia is also good because this method is feasible when using one species preparation - local anesthetic (if necessary, so-called adjuvants can be used - substances that prolong and strengthen block). That is, the body introduces a minimum amount of drugs, but at the same time, the necessary level of anesthesia is reached, in which the operation becomes possible.

Another advantage of regional anesthesia is that during the operation the patient's consciousness is not inhibited by medications, that is, An anesthesiologist can have contact with the patient throughout the operation, respond promptly to complaints that arise and to the changing the situation as a whole. This also excludes the presence of post-amniotic depression of consciousness, nausea and vomiting, respiratory depression and other, which is quite likely after using general anesthesia methods.

The disadvantage of specifically spinal anesthesia is the fact that it is possible only in operations on the lower half of the body: lower extremities, perineum, in the pelvic area, in the lower parts stomach. However, at the present time, there are methods of regional anesthesia that allow surgery on the upper limbs.

Another drawback of spinal anesthesia is the side effect of one of its advantages: during the operation, the patient's consciousness is preserved, this is good for Anesthesiologist, however, in patients with unstable psyche, a sense of fear, anxiety and anxiety may develop, especially if the premedication has been performed unduly way. However, this deficiency is easily leveled by means of superficial sedation; that is, the patient is administered a drug that causes sleep and relieves anxiety. Thus, it is much better and safer than at least five different groups of drugs administered with general anesthesia.

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In the postoperative period, patients undergoing surgery under spinal anesthesia may develop a so-calledpost-puncture headache.

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This is due to the imminent occurrence of a defect in the dura mater emerging during anesthesia and subsequent leakage through it of cerebrospinal fluid (cerebrospinal fluid).

I must say that these pains occur when the patient makes a vertical position (sitting, standing) and almost immediately disappear when returning to a horizontal position.

This significantly reduces the likelihood of a post-puncture (after a nyxis in the back) headache. In addition, it should be noted that the modern arsenal of anesthesiologist includes spinal needles of extremely small size in cross-section: these needles are so thin that they leave a defect of insignificant dimensions in the shell, which also reduces the risk complications

Comparison of a needle for spinal anesthesia with a needle from a 5 ml syringe

Given these facts, it can be rightly stated that regional anesthesia, although having a number of disadvantages, is more safe for the patient, and, if possible, it serves method of choice.

Who should not have spinal anesthesia?

Like any other method of anesthesia, spinal anesthesia has a number of contraindications. An anesthesiologist will not do this if the patient has:

• information about an allergic reaction to a local anesthetic;
• inflammatory lesion of the skin at the site of the alleged injection;
• significant deformation (curvature) of the spine;
• psychoneurological disorders, when the patient himself can not accept the necessary position of the body;

• reduced blood clotting and so on.

  In the case of an episode of allergy to a local anesthetic, the patient should performallergic test, and its results to be given to the anesthesiologist.

  In the case of a decrease in blood clotting (which happens when taking anticoagulants), you should cancel the anticoagulants (most often warfarin) and follow the laboratory indicators of blood clotting (hemostasiogram / coagulogram).

It is important to remember that the patient must be taken to the operating room with an empty stomach and performed premedication, and also without metal ornaments and removable dentures.

How to behave during spinal anesthesia

The technique of spinal anesthesia is relatively simple, but requires careful attention not only from the physician, but also from the patient.

Before the start of the exercise, the patient is placed on the operating table, monitoring is set up (arterial pressure, pulse, ECG, etc.), the peripheral venous catheter is placed and the beginning of infusion (administration liquid). Then the patient sits down on the table or lies on his side (as an anesthesiologist will say). At this point, the patient should carefully follow the instructions of the anesthesiologist, since the correct position of the patient's body makes it much easier to perform spinal anesthesia. The patient sits on the table, puts his feet on a chair and as much as possible "stoops archs the lower back to the anesthesiologist, while not leaning forward.

The position of the patient during spinal anesthesia

When performing anesthesia, pain can occur when the needle is pricked, the subcutaneous structures are passed - the patient's debt when this is patiently in the initial position, as shudders and twitches can prevent manipulation and tighten process. After the anesthesiologist reaches the necessary structures, the injection will begin, a few seconds after which the patient will feel a rush of heat to the lower limbs, as well as their growing numbness. The anaesthesiologist will necessarily ask about all this, so it is important to listen sensitively to your feelings and answer as accurately as possible. One must understand and remember that the lack of movements in the legs does not appear immediately, but after a while; therefore if after anesthesia you were put on table, and you see the surgeon approaching you with a scalpel - do not panic, even if the movements in the legs are still there, they will soon disappear, at that time as the pain sensitivity has long gone (especially since no one will start the operation until the anesthesiologist is sure that you really do not painfully).

During the operation, the anesthetist maintains contact with the patient, whose duty during this period to report all the problems that arise, whether it be nausea, anxiety or even a combed nose.

It is the duty of the anesthesiologist to respond immediately to the situation that has arisen.

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After the operation is completed, the anesthetist gives prescriptions about what follows and what should not be done after surgery to reduce the risk of complications.

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Summarizing the above, it can be noted that at present regional anesthesia (and in particular spinal anesthesia) is safer than general anesthesia, for the patient by anesthesia with a number of significant benefits.

A source: https://medsila.com/lechenie/operation/anesteziologia/spinalnaja-anestezija