| What is a regional anesthetic?
Spinals, epidurals and
combined spinal-epidurals are regional anesthetics. A section or
“region” of the body is numbed by the medicine that is injected into the
spinal canal. The legs, the torso and part of the chest are the areas
that become numb.
What’s the difference
between a spinal and epidural and a combined spinal-epidural?
The spinal cord and the
nerves are contained in a sac of cerebrospinal fluid. The space
around this sac is the epidural space (see section on 'Regional anesthesia').
Spinal anesthesia involves the injection of numbing medicine directly
into the fluid sac. Epidurals involve the injection into the space
outside the sac (epidural space). Spinals and epidurals have the same
effect (i.e. numbs a large region of the body) because they both involve
numbing of the nerves as they branch off the spinal cord. Since
the spinal injection is more “direct”, the effect is immediate.
Spinals are usually the first choice of anesthetic for women who are not
in labor but need a Cesarean delivery. Epidural anesthesia takes
a little longer to establish desired affect. Because a small tube
(catheter) can easily be placed in the epidural space, repeated doses
of medicine can be given to maintain anesthesia as long as needed.
Epidurals are the primary way of relieving pain in women that request
analgesia for labor. A combined spinal-epidural involves a spinal injection
followed by the insertion of an epidural catheter. Quick onset can be
achieved with the spinal part. Further maintenance of the anesthesia
is achieved through the epidural catheter.
How is a spinal anesthetic
The procedure for spinal
anesthesia is similar to epidural anesthesia for labor or for cesarean
delivery (see picture). The difference is that medicine is injected
directly into the spinal sac. A thin needle is used to reduce the
chances of a spinal headache.
How will I know if
the spinal is working?
Many women describe an
immediate feeling of warmth and tingling in the feet which extends up
the legs and torso as the spinal anesthetic takes effect. Your legs
will then begin to feel numb and heavy. Although your ability
to breathe is not changed, the spinal does numb the chest area as well,
so the sensation of breathing will feel altered with a subjective
sensation of feeling 'short of breath.' Although you are breathing
adequately, your brain does not appreciate the movements of your chest
due to chest numbness. As long as your hands are not weak and your are
able to talk, be reassured that you are breathing adequately. In addition,
you can sense moisture condensation on the mask during each breath. Moreover,
you should always remember that the anesthesiologist is monitoring and
watching your breathing, oxygen levels, blood pressure, heartbeat and
other vital signs. After the spinal is placed, the anesthesiologist will
check the level of anesthesia by assessing the extent of the numbness.
It is normal for the body to feel numb from the lower chest down to the
feet. This is considered the right amount of anesthesia to keep
you comfortable for the operation.
Can a labor epidural be used for Cesarean delivery?
Some women who go through labor might eventually require a Cesarean delivery.
This can be due to non-urgent factors (labor not progressing), or urgent
factors (mother or baby’s condition is at risk). If an epidural catheter
has been in place and functioning well, most of the time the anesthesiologist
can put additional medicine into the catheter to make the numbness adequate
for surgery. As with spinal anesthesia, it is normal for the body
to feel numb from the lower chest down to the feet. Again, this
is considered the right amount of anesthesia to keep you comfortable for
the operation. If the epidural does not work, it may be replaced,
or spinal or general anesthesia may be used. This choice depends
on the urgency of the situation. This is, however, uncommon.
Will I feel anything if I’m awake for the operation?
With a spinal or epidural anesthetic, you should not feel any pain with
the operation. Being awake, you will still be aware of movements
occurring in your lower body. Specifically, you may sense a feeling of
“pulling and tugging” as the obstetrician separates the abdominal muscles
and tissues. In addition, at the time of delivery, the obstetrician
will push down on your abdomen to facilitate the delivery of the baby.
You will feel this sensation as pressure in your chest.
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