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Anaesthetic – (Your spinal anaesthetic)

For many operations, a general anaesthetic is used, keeping the patient unconscious. However, a spinal anaesthetic can be used as an alternative for some procedures. Depending on the type of surgery and your medical condition, a spinal anaesthetic may be a safer and more suitable option for you than a general anaesthetic. Almost any operation performed below the waistline is suitable for a spinal.

When you have a spinal anaesthetic, you can normally choose:

• To remain fully conscious.
• To have mild sedation, which makes you relaxed and drowsy while remaining conscious.
• Occasionally, to have the spinal anaesthetic combined with a general anaesthetic.

What is a spinal anaesthetic?

A spinal is a type of anaesthesia where a local anaesthetic drug is injected through a needle into the small of your back. This numbs the nerves from the waist down to the toes for a period of two to three hours.

How is the spinal performed?

Your anaesthetist will discuss the procedure with you beforehand on the ward. An anaesthetic assistant will also be with you in the theatre. A thin plastic tube (a ‘cannula’) will be inserted into a vein in your hand or arm. You will be helped into the correct position. This will either be sitting on the side of the bed with your feet on a low stool, or lying on your side, curled up with your knees tucked towards your chest. Staff will support and reassure you during the injection. The anaesthetist will explain what is happening throughout the procedure. Once the injection is given, the anaesthetist will stay with you, measuring the progress of the anaesthetic and testing its effectiveness. You will only be prepared for the operation when you and the anaesthetist are completely happy that it has taken full effect.

What will i feel?

The procedure should only take a few minutes and is not usually unpleasant. As the injection is made, you might feel pins and needles or a sharp tingle in one of your legs. If this happens, try to remain still and tell your anaesthetist. After the injection, you will lie flat. The spinal works quickly, usually within 5 to 10 minutes. Initially, your skin will feel numb to the touch and your leg muscles will feel weak. When the anaesthetic is fully working, you will be unable to move your legs or feel any pain below the waist. During the operation, you may be given oxygen through a lightweight, clear plastic mask.

Why have a spinal?

The advantages of a spinal anaesthetic may include:

• Reduced blood loss during surgery and less need for a blood transfusion.
• Lower risk of blood clots (DVT) and chest infections after surgery.
• Less effect on the heart and lungs.
• Excellent pain relief immediately after surgery, with less need for strong pain-relieving drugs.
• Less sickness and vomiting.
• An earlier return to drinking and eating.
• Less confusion after the operation in older people.
• With a spinal, you can communicate with the anaesthetist and surgeon. If a camera is used during your surgery, you may even be able to watch the operation on a screen if you wish.

Operations where a spinal is commonly used:

• Orthopaedic surgery: Major operations on leg bones or joints.
• General surgery: Hernia repair, varicose veins, piles (haemorrhoids).
• Vascular surgery: Repairs to the blood vessels of the leg.
• Gynaecology: Vaginal repair or operations on the bladder outlet.
• Urology: Prostate removal, bladder operations, and genital surgery.

You may still need a general anaesthetic if the spinal cannot be performed satisfactorily, it does not work as expected, or the surgery is more complicated than anticipated.

Side effects and complications

Like all anaesthetic techniques, there is a possibility of unwanted side effects.

Very common and common side effects:

These are usually easily treated and do not last long.

• Low blood pressure: As the spinal takes effect, your blood pressure may drop, making you feel faint or sick. This can be controlled with fluids from your drip and medication.
• Itching: This can be a side effect of morphine-like drugs used in combination with the local anaesthetic. It can be treated if you tell the staff.
• Difficulty passing water (urinary retention): You may find it difficult to empty your bladder while the spinal lasts. Function returns to normal afterwards. A temporary catheter may be needed.
• Pain during the injection: You should immediately tell your anaesthetist if you feel any pain or pins and needles, as the needle may need to be repositioned.
• Headache: There is a risk of developing a headache when the spinal wears off and you begin to move around.

Rare complications:

• Nerve damage: This is a rare complication. Temporary loss of sensation, pins and needles, or muscle weakness can last for a few days or weeks but almost always results in a full recovery. Permanent nerve damage is very rare.

After your spinal

Nurses will ensure the numb area is protected from pressure and injury until sensation returns, which typically takes 1.5 to 4 hours. You should inform the ward staff about any concerns you have. As sensation returns, you may feel some tingling. When you start to feel pain from the operation site, you should ask for pain relief before it becomes too severe. Ask for help when you first get out of bed. You can normally drink fluids within an hour of the operation and may be able to eat a light diet.

Frequently asked questions

• Q: Can i eat and drink before my spinal?
  • A: No, you will need an empty stomach and must follow the same fasting rules as for a general anaesthetic. This is a precaution in case it becomes necessary to switch to a general anaesthetic.
• Q: Must i stay fully conscious?
  • A: You and your anaesthetist can decide this together. You can remain fully awake or be lightly sedated.
• Q: Will i see what is happening to me?
  • A: A screen is normally placed across your chest so you don’t see the surgery. For ‘keyhole’ surgery, some patients like to watch the procedure on the video screen. You will be aware of the initial ‘hustle and bustle’ of the theatre, but it will quieten down once surgery starts.
• Q: Do i have a choice of anaesthetic?
  • A: Yes. Your anaesthetist will assess your preferences and needs and discuss the options with you.
• Q: Can i refuse to have a spinal?
  • A: Yes. If you are unhappy about having a spinal after discussing it with your anaesthetist, you can always say no.
• Q: Will i feel anything during the operation?
  • A: Your anaesthetist will ensure the spinal is working properly before surgery begins. You should not feel any pain, but you may be aware of other sensations like movement or pressure.
• Q: Should i tell the anaesthetist anything during the operation?
  • A: Yes. Your anaesthetist will want to know about any sensations or feelings you experience so they can adjust your care and explain what is happening.
• Q: Is a spinal the same as an epidural?
  • A: No. Although both involve an injection in the small of your back, they work in slightly different ways and should not be confused.
• Q: Where can i learn more about spinals?
  • A: For more detailed information, please speak to your anaesthetist or contact the anaesthetic department.

Patient advice & liaison service (PALS)

PALS staff are available to offer advice or information on healthcare matters.

• Office: Main Foyer (Gate 4) of Doncaster Royal Infirmary.
• Contact: Can be made in person, by telephone, or by email. PALS staff can also visit inpatients on all Trust sites.
• Telephone: 01302 553140 or 0800 028 8059

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