Spinal anesthesia is one of the methods of pain relief from surgical operations and manipulations. The method is also widely used when performing a cesarean section. In this material we will talk about what this anesthesia is, how it is done and what are its advantages and disadvantages.
What it is?
Inside the human spinal column, nerve endings are concentrated, which constantly send certain impulses to the brain, on which the work of the central nervous system is based. If you block the sending of these "messages", then the brain will not perceive the signals of pain or cold, touch. This is the basis of spinal anesthesia for caesarean section.
The operation is associated with an incision and penetration into the abdominal cavity, and therefore must be carried out with the use of anesthesia without fail. But the choice of anesthesia is a rather difficult question, because there are several types of anesthesia for this operation. Epidural and spinal anesthesia are classified as regional anesthesia.
The only difference between them is that with epidural anesthesia, drugs that block the sensitivity of nerve endings are injected into the epidural space, and with spinal anesthesia - into the subarachnoid space of the spine, that is, somewhat deeper than in the first case.
Such penetration makes it possible to block nerve impulses at the level of the roots of the spinal nerves. The drugs that are administered during cesarean section are highly purified and do not contain preservatives. This is usually one of the anesthetics, such as lidocaine, with the addition of opiates, such as promedol. Recently, ketamine has often been used.
It is believed that spinal anesthesia is superior to epidural in the quality of pain relief, and also better than general anesthesia, just because the way out of it is easier, not associated with nausea and severe dizziness.
The patient is conscious during the entire operation, understands everything, can communicate with doctors, but does not feel the lower body from the waist to the tips of the toes. At the same time, the upper body retains sensitivity, a woman can move her arms and head, which gives her a unique opportunity to hug her baby immediately after his birth. For this, in fact, many women in labor and insist on spinal anesthesia.
How is it done?
Medicines are injected into the spine through a lumbar puncture. In this case, the woman either sits, leaning forward as much as possible, or lies on her side, tilting her head to her chest. To numb the lower body, the anesthesiologist inserts a puncture needle into the lumbar spine. The insertion point is located between the vertebrae. The needle itself is thinner than with epidural anesthesia. The needle must pass through the space of the yellow ligament between the vertebrae without touching them, bypass the epidural space and penetrate into the subarachnoid space filled with cerebrospinal fluid.
It should be noted that less drugs are required for spinal anesthesia than for epidural, and the effect occurs much faster. In most cases, epidural analgesia takes about 15 minutes, and numbness in the lower body and subsequent loss of sensation with spinal anesthesia occurs within seconds after insertion.
Typically, medication is injected into the space between two vertebrae in the 2 and 5 lumbar vertebrae to achieve permanent pain relief during a cesarean section. Most often, doctors choose a point between the 2nd and 3rd vertebra of the lumbar spine.
The question of how painful it is is often asked by women. In most cases, the woman in labor does not experience sharp pain. Depending on the individual sensitivity, there may be short-term discomfort, the same as with any injection. If a woman feels unpleasant sensations, she must definitely inform the anesthesiologist about this. The main thing is not to turn to a specialist, not to try to look at him. A woman should carry out all communication without changing her body position.
After making sure that the puncture needle is in the right place, the doctor injects a test dose of medication. After 3-5 minutes, in the absence of negative signs, the rest is introduced in stages and in parts. During the operation, the doctor can adjust the degree of blockage by adding or reducing the dosage of the drugs administered.
At the signal from the surgeon to complete the operation, the catheter is removed from the back. The woman is transferred to the intensive care unit, where not only obstetricians, but also the anesthesiologist himself observe her for several hours to make sure that the recovery from anesthesia will pass without complications. It takes about 2 hours.
Potential consequences and complications
Spinal anesthesia is considered a fairly safe method of pain relief. The statistics of the Russian Ministry of Health show that the probability of severe or fatal complications is 0.01%. This means that for 10 thousand operations with the use of such anesthesia, there was only one death of a patient, the cause of which was acute heart failure.
Many women complain of back pain and headache after surgery. Post-puncture pain is a fairly common phenomenon and occurs in about 7-10% of women in labor. They are temporary in nature and usually disappear completely within 2-3 months without the use of any special treatment.
Another likely complication of spinal anesthesia is a drop in blood pressure in the early postoperative period. This occurs in about 2-3% of cases. The situation is under control and is being solved by the administration of drugs that increase blood pressure.
Much depends on the level of training, experience and qualifications of the anesthesiologist. An inexperienced and inept doctor can injure the spinal cord, the hard membranes of the vertebrae, in this case, various disorders of the central nervous system are possible, from a feeling of prolonged numbness in the limbs to paralysis. The probability of such complications, according to statistics, is low, but it exists.
In 15% of cases, a persistent analgesic effect cannot be achieved, the sensitivity of the woman in labor can be preserved to a certain extent, which is extremely undesirable for either the patient or the doctor who performs the operation.
If there is a violation of blood clotting, coagulopathy, a small hemorrhage may appear at the puncture point - a hematoma. The subarachnoid space, where medications are injected, requires precision, its injury is fraught with the development of seizures and paralysis.
Since the doses of drugs are reduced compared to other types of anesthesia, drugs affect the baby to a lesser extent than with epidural and general anesthesia. But nevertheless, there remains an insignificant likelihood of violations of the heart rate in a child, weakness of breath, hypoxia, muscle hypotension in the neonatal period.
Some women note the extremely difficult psychological background of the operation under spinal anesthesia - being conscious and understanding that it is you who are being cut on the table, and also hearing the doctors' conversations during the operation, it is not so easy for the psyche as it seems. Especially impressionable women already at the very beginning of the operation begin to demand general anesthesia from doctors in order to fall asleep and wake up only when everything is over.
Contraindications
There are two types of contraindications for such anesthesia. Some are relative and some are absolute. Always absolutely spinal anesthesia is contraindicated in women with:
- severe blood clotting disorders;
- infectious and inflammatory diseases of the skin in the area of 2-5 lumbar vertebrae, that is, where it is supposed to introduce a puncture needle;
- high intracranial pressure;
- spinal injuries, deformation of the spinal column;
- severe heart disease.
Relative contraindications for spinal anesthesia are:
- severe psychological and emotional disorders of a pregnant woman, mental illness;
- indefinite duration of the operation (if, for example, doctors assume that amputation of the uterus due to ingrowth of the placenta may be required, or the woman has consented to surgical sterilization after a cesarean section);
- fetal death;
- bleeding in a woman, or suspected bleeding.
Also, the patient will be denied in performing spinal anesthesia if the caesarean section is performed not as planned, but for emergency indications. In this case, the child must be removed from the mother's womb as soon as possible; for this, general (endotracheal) anesthesia is considered optimal.
Reviews
Many women who have gone through such anesthesia by cesarean section claim that they tolerated the postoperative period quite gently and well. Only a few note that it is painful to do the puncture itself, and few indicate that unpleasant sensations (as if you were being gutted) persisted throughout the operation.
Serious disadvantages of women include post-puncture pain in the head and back. They especially interfere in the first weeks, since it can be extremely unpleasant to sit and walk.
Some young mothers, according to reviews on thematic forums, and for 3-4 months after a cesarean section continue to experience numbness and tingling in their legs from time to time, as well as increased swelling of the legs. In this case, there are usually complaints of memory impairment and absent-mindedness.
Women, on whom spinal anesthesia did not work enough, claim that it was painful and scary, and therefore they will never give consent to such anesthesia in the future.
For more information on spinal anesthesia for caesarean section, see the following video.
