09/15/2018 / 396 / Muhamad Rawi
As an anesthetist, I felt that i have an obligation to write this article. In many countries around the world including some of the modern countries, spinal anesthesia still have this bad reputation. Everyday this situation is repeating itself over and over again, imagine this: there is that pregnant woman who is going for c-section or this man in his 40's who is going for inguinal hernia repair or even that old lady who is going for hip joint replacement, there is that pre-anesthesia visit to evaluate the medical condition and the options we have for anesthesia. Some patients are well tolerating the idea of spinal anesthesia but some others are strongly refusing even considering it. The main cause of patient refusal to have spinal anesthesia would be mainly based on false facts they heard from friends, relatives, or even their surgeon. Reasons vary between fear of having a permanent injury to their spinal cord and subsequently not being able to walk properly again, or having a post-operative headache, or a permanent pain at their back that lasts for their remaining life time. Some other patients are hysteric and they can't even tolerate the idea of being awake during the surgery. Well, we are going to discuss in this article what is right or wrong about spinal anesthesia based on scientific facts and medical practice.
Spinal anesthesia is performed by your anesthetist simply by injecting some local anesthetic at your back at the level of lumbar vertebral space between the fourth and fifth lumbar vertebrae usually, the level may vary according to the surgical procedure to be performed. You may or may not be given a sedative prior to performing spinal anesthesia. Then, your anesthetist will advance some relatively longer needle in between your vertebrae to reach the subarachnoid space to inject the local anesthetic according to pre-calculated dose. You will start to feel numbness in your legs or hotness or both. You will lose leg movement usually or may still preserve some minor leg movement according to anesthetic procedure performed. Then the medical staff at the OR will put some barrier between you and the surgeon so-that you wouldn't see them operating on you. You will be awake and talking (mostly to the anesthetist) and even he might tell you some joked until the surgeon finishes the surgery.
First of all we need to tell you that your anesthetist understands your fears about spinal anesthesia and he will be happy to answer any questions you have about spinal anesthesia, the second point is that nobody can force you to have spinal anesthesia and the anesthetists will never force you for it (according to medical practice guideline this would be an absolute contraindication to give you spinal anesthesia if you refuse). So no we get to the wrong assumptions by some people about spinal anesthesia:
1- Will it hurt my spinal cord? As we said before, the anesthetist usually administers the spinal needle at the lumbar 4-lumbar 5 space and the spinal cord in adults ends usually at the lumbar 1 - lumbar 2 space, there are 3 big vertebrae between the needle and your spinal cord (about 10-15 cm) which is far away from your spinal cord, so mostly you won't be hurt by the spinal needle. 2- Will I feel any pain during the surgery? No, or we wouldn't even allow spinal anesthesia, however you might feel a slight sensation of touch or pressure by surgeon hands, these sensations might persist and you shouldn't freak out. 3- Is it so painful , the spinal needle administration? No, it is not painful as your anesthetist may give you some local anesthesia before administering the needle or even some general sedation if your medical condition is fit for it. 4- Will spinal anesthesia end during surgery and what happens then? Your anesthetist will evaluate the surgical time you need for surgery and will ensure it lasts even after you finish your surgery. However, events do happen and your surgery may not go as planned and take a longer time (spinal anesthesia lasts for 3-5 hours usually), your anesthetist will never allow you to feel any pain and may decide anytime to give you general anesthesia till the surgery finishes.
The most important advantage is that you still awake, you can complain anything and consult your anesthetist who will be there to help you. Spinal anesthesia will spare you the risks of mechanical ventilation like respiratory infection or even failures of ventilation machines, these things shouldn't happen anyway but why take the risk. Spinal anesthesia will spare you the risk of being administered many drugs you get to get when given general anesthesia, you may have some allergy to any drugs that you don't know about and some of these allergic reactions are fatal. Spinal anesthesia will spare you great loss of blood, for a usual c-section the predicted blood loss under general anesthesia is 800 cc of blood while under spinal anesthesia, the predicted loss is only 400 cc. Spinal anesthesia will also provide you with a better post operative recovery and less pain sensation, it is related to faster recovery and discharge times than general anesthesia.
The main disadvantage is that some people get a sever headache post-spinal anesthesia and this could be greatly minimized if your anesthetist takes his precautions, just follow the instructions he gives you carefully and you will be safe from headache. Another disadvantage is suffering hypotension during surgeries and your anesthetist is aware of that too and will take his precautions so that your blood pressure stays stable. Some other minor complications include cauda equina syndrome or meningitis but you don't know these medical terms anyway, just choose a well equipped hospital with good sanitary conditions and you will be safe (in case you live in a developing country).
Well, spinal anesthesia has been proven to be more safer than general anesthesia and provides a better surgical experience, at least you will get to listen to your anesthetist's silly jokes !. However, some medical conditions are not fit for spinal anesthesia but let that for your anesthetist to assess and if he advises you with spinal anesthesia, he is just telling you the right thing to do. Stay calm, help him, and follow his instructions and you will enjoy it.
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