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Spinal Anesthesia

Welcome to our section about spinals. We will talk about what a spinal is, when you can get one, side effects, and potential complications.

What is a Spinal?

Spinal anesthesia is similar to an epidural, the difference is how deep medicine is placed. A spinal goes deeper into your back than an epidural. Spinal anesthesia uses a small needle to puncture the spinal cord sac. Medication is placed inside the sac near your spinal cord. Unlike an epidural, nothing is left in your back.

Spinal anesthesia works quickly and numbs all feeling from your belly to your toes

When can I get a Spinal?

Spinal anesthesia is most commonly used right before cesarean delivery (c-section). This avoids having to put patients to sleep with general anesthesia. Spinal anesthesia last around an hour to an hour and a half.

Who places a Spinal?

A spinal is placed by an anesthesia provider- an anesthesiologist or a certified registered nurse anesthetist (CRNA). These providers go through rigorous training to place spinals and manage any problems from them.

Provider: A doctor or advanced practice nurse.

Anesthesiologist: A doctor that is trained to provide anesthesia.

Certified Registered Nurse Anesthetist: A nurse that is trained to provide anesthesia..

Spinal Placement

Spinal anesthesia is used right before cesarean delivery (c-section). This avoids having to put you to sleep with general anesthesia. Spinal anesthesia last around an hour to an hour and a half.

When you ask for a spinal, your doctor will make sure that a spinal will be safe for you. There are a few conditions where it is not safe to have a spinal. After your doctor orders a spinal, an anesthesia provider will come to talk to you. You will be told about the benefits and risks of a spinal and you will be asked to sign a consent form. .

After you sign the consent form, the procedure generally goes as follows:

1. Getting into Position

You will be asked to sit at the edge of the bed or to lay on your side. Your nurse will assist you into one of these positions.

2. Cleaning your back

The anesthesia provider will clean your lower back and place a drape on your back to prevent infection.

3. Numbing medicine

Numbing medicine will be injected into your skin using a very small needle. This helps you not feel the epidural needle. This is usually the most painful part of the procedure.

4. Spinal Needle

The anesthesia provider will place a different needle into the site. It is very important to stay as still as possible!

8. All Done

Your provider will let you know when the medicine is given. Nothing will be left in your back.

9. Relief

You will begin to feel the effects of the medicine after a few minutes. Your legs and belly will slowly get weak and numb.

10. Safety Check

Your anesthesia provider will check where you are numb. This lets your provider know your spinal is working

How a Spinal changes your care

Our goal is your safety and comfort

Care around spinals:

Spinals make it hard to go pee. You will need a catheter to help you pee.

You will not be able to eat or drink to prevent nausea and vomitting until the medication wears off

Your nurse will help you move in the bed because your legs will be weak

You will be asked to not get out of bed because of leg weakness

Spinal Benefits

Lower Pain Scores

When compared to other pain medications or no medications, Those who get a spinal have lower overall pain scores.

Less Nausea/Vomitting

Compared to other pain medicines, spinals have a lower chance of causing nausea and vomiting.

Higher Patient Satisfaction

Spinals help relieve pain and anxiety associated with labor pain, allowing you to focus on your special day.

Lower Chance of Breathing Problems

Other pain medicines have a higher chance of making it hard to breathe

Less Pain Medication

Those who get a spinal use less additional pain medicine during labor

Better APGAR scores

APGAR is a tool used by doctors to check for how awake a baby is after birth. The higher the score, the less likely a baby needs additional hospital care

Side Effects

Side effects of spinals are the same as epidurals.

Common side effects after placement:

Dizziness
Nausea/Vomiting
Low blood pressure
Shivering

Please tel your nurse, anesthesia provider, or obstetric provider if you feel any of these symptoms as they can be signs of overdose:

Tinnitus (Ringing in the ears)
Numbness or tingling around your lips

Effects of overdose can include:

Seizures
Syncope
Respiratory Depression
Coma
Cardiac arrest

Potential Complications

Risks with getting a spinal are well-known. There are multiple safeguards to prevent injury. Like any medical procedure, spinals have their risks.

Post-dural Puncture Headache

The most common injury from an spinal is called a post-dural puncture headache. This happens when the hole made by the spinal needle to give you medication does not close on its own. This is an uncommon complication, but it can be uncomfortable. This injury causes a headache that gets worse when standing up and gets better with laying flat.

There are a few treatments for this injury. Treatments include pain medicine such as Tylenol or a epidural blood patch. An epidural blood patch is when an anesthesia provider draws blood from your arm and puts it into your back. The blood is injected in the same area as where the spinal was. The injected blood will plug up the hole caused by the epidural. The procedure is similar to placing an epidural. Headaches usually get better right after the blood patch is placed. However, it can take a couple days to notice an improvement.

Most post-dural puncture headaches get better without treatment. Headaches can last for a few weeks.

Infection

Like any procedure, there is a small chance for infection. There are many safeguards prevent infection but there is still a risk. Depending on the infection, treatment includes antibiotics or surgery.

FAQs

1. What is the difference between a spinal and a epidural?

The difference is where the medicine is placed. Medicine in a spinal goes deeper into your back. Spinals work within a few minutes but only last up to an hour and a half. In an epidural, a plastic tube is left in your back to give more medication. A spinal is just one injection into your back.

2. If the spinal medicine goes away, do I need another one?

If there are problems with your labor, you may need more spinal medicine or use other forms of pain management. One study showed that 14% of those that get a spinal need additional medicine.

Where Did We Get This Information?

American Pregnancy Association. (n.d.). Epidural- Everything you need to know about it. American Pregnancy Association. Retrieved on October 4th, 2023 from https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/what-is-an-epidural/

Barash, P. G., Cahalan, M. K., Cullen, B. F., Stock, M. C., Stoelting, R. K., Ortega, R., Sharar, S. R., & Holt, N. F. (2017). Clinical Anesthesia (8th ed.). Elsevier

Halliday, L., Nelson, S. M., Kearns, R. J. (2022). Epidural analgesia in labor: A narrative review. International Journal of Gynecology & Obstetrics, 159 (2), 356-364. https://doi.org/10.1002/ijgo.14175

Johns Hopkins Medicine. (n.d.). Epidurals for Labor Fact Sheet. Johns Hopkins Medicine. Retrieved on October 4th, 2023 from https://anesthesiology.hopkinsmedicine.org/wp-content/uploads/2019/04/Epidural-Handout-11-20-2018.pdf

National Health Service. (2023, February 01). Epidural. National Health Service. Retrieved on October 4th, 2023 from https://www.nhs.uk/conditions/epidural/

Sharpe, E.E., Kim, G. Y., Vincent, N. J., Arendt, K. W., Hanson, A. C., Martin, D. P., & Sviggum, H. P. (2019). Need for additional anesthesia after single injection spinal analgesia for labor: A retrospective cohort study. International Journal of Obstetric Anesthesia, 40, 45-51.https://doi.org/10.1016/j.ijoa.2019.05.013

Smith, A., LaFlamme, E., & Komanecky, C. (2021). Pain management in labor. American Family Physician, 103(6), 355-364.