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 9 cm (3.5 in) long. It is a safe and effective form of anesthesia performed by anesthesiologists and nurse anesthetists which can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic or opioid injected into the cerebrospinal fluid provides anesthesia, analgesia, and motor and sensory blockade. 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).

Risks and complications

Complications of spinal anesthesia can result from the physiologic effects on the nervous system and can also be related to placement technique. Most of the common side effects are minor and are self-resolving or easily treatable while major complications can result in more serious and permanent neurological damage and rarely death. These symptoms can occur immediately after administration of the anesthetic or arise up to 48 hours after surgery.

Common and minor complications include:

• Mild hypotension
• Bradycardia
• Nausea and vomiting
• Transient neurological symptoms (lower back pain with pain in the legs)
• Urinary retention
• Post-dural-puncture headache or post-spinal headache

Serious and permanent complications are rare but are usually related to physiologic effects on the cardiovascular system and neurological system or when the injection has been unintentionally at the wrong site. The following are some major complications:

• Nerve injuries: Cauda equina syndrome, radiculopathy
• Cardiac arrest
• Severe hypotension
• Spinal epidural hematoma, with or without subsequent neurological sequelae due to compression of the spinal nerves.
• Epidural abscess
• Infection (e.g. meningitis)

Current Issue: Volume 3: Issue 2

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