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Spinal and epidural anesthesia

Spinal and epidural anesthesia are medicines that numb parts of your body to block pain. They are given through shots in or around the spine.

Description

The doctor who gives you epidural or spinal anesthesia is called an anesthesiologist.

First, the area of your back where the needle is inserted is cleaned with a special solution. The area may also be numbed with a local anesthetic.

You'll likely receive fluids through an intravenous line (IV) in a vein. You may receive medicine through the IV to help you relax or sleep lightly.

For an epidural:

  • The doctor injects medicine just outside of the sac of fluid around your spinal cord. This is called the epidural space.
  • The medicine numbs, or blocks feeling in a certain part of your body so that you cannot feel pain. The medicine begins to take effect in about 10 to 20 minutes. It works well for longer procedures. Women often have an epidural during childbirth.
  • A small tube (catheter) is often left in place. You can receive more medicine through the catheter to help control your pain during or after your procedure.

For a spinal:

  • The doctor injects medicine into the fluid in your spinal cord. This is usually done only once, so you will not need to have a catheter placed.
  • The medicine begins to take effect right away. It works well for shorter and simpler procedures.

Your pulse, blood pressure and oxygen level in your blood are checked during the procedure. After the procedure, you will have a bandage where the needle was inserted.

Why the Procedure is Performed

Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). Patients usually recover their senses much faster. Sometimes, they have to wait for the anesthetic to wear off so they can walk.

Spinal anesthesia is often used for genital, urinary tract, or lower body procedures.

Epidural anesthesia is often used during labor and delivery, and surgery in the pelvis and legs.

Epidural and spinal anesthesia are often used when:

  • The procedure or labor is too painful without any pain medicine.
  • The procedure is in the belly, legs, or feet.
  • Your body can remain in a comfortable position during your procedure.
  • You want fewer systemic side effects and a shorter recovery than you would have from general anesthesia.

Risks

Spinal and epidural anesthesia are generally safe. Ask your doctor about these possible complications:

  • Allergic reaction to the anesthesia used
  • Bleeding around the spinal column (hematoma)
  • Difficulty urinating
  • Drop in blood pressure
  • Infection in your spine (meningitis or abscess)
  • Nerve damage
  • Seizures (this is rare)
  • Severe headache

Before the Procedure

Tell your doctor or nurse:

  • If you are or could be pregnant
  • What medicines you are taking, including medicines, supplements, or herbs you bought without a prescription

During the days before the procedure:

  • Tell your doctor about any allergies or health conditions you have, what medicines you are taking, and what anesthesia or sedation you have had before.
  • If your procedure is planned, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
  • Ask your doctor which medicines you should still take on the day of your procedure.
  • Arrange for a responsible adult to drive you to and from the hospital or clinic.
  • If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of the procedure:

  • You may be told not to drink or eat anything after midnight the night before the surgery.
  • Do not drink alcohol the night before and the day of your procedure.
  • Take the medicines your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you what time to arrive at the hospital. Be sure to arrive on time.

After the Procedure

After an epidural, the catheter in your back is removed. You lie in bed until you have feeling in your legs and can walk. You may feel sick to your stomach and be dizzy. You may be tired.

After spinal anesthesia, you lie flat in bed for a few hours to keep you from getting a headache. You may feel sick to your stomach and be dizzy. You may be tired.

Outlook (Prognosis)

Most people feel no pain during spinal and epidural anesthesia and recover fully.

Alternative Names

Intraspinal anesthesia; Subarachnoid anesthesia; Epidural; Peridural anesthesia

References

Brull R, MacFarlane AJR, Chan VWS. Spinal, epidural, and caudal anesthesia. In: Miller RD, ed. Miller's Anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 56.

Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 16.

Update Date 6/29/2015

Updated by: Jennifer Sobol, DO, Urologist at the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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