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Spinal anesthesia is a way to eliminate pain during certain procedures or surgeries by injecting medication into the spinal canal to interrupt nerve transmissions from the lower half of the body.

Who is a candidate for the procedure?

This procedure is commonly called "a spinal." It is usually used for procedures below the rib cage. It is an attractive alternative to general anesthesia for a person who needs a major operation but has medical complications that might make it difficult to tolerate or recover from general anesthesia.

How is the procedure performed?

A needle or special tube is inserted through the skin of the back until it enters a special sac that surrounds the spinal cord. Medication is then injected through the needle or tube. The medication blocks the impulses in the nerves that come from the spinal cord.

Spinal anesthesia is similar to but has certain differences from epidural anesthesia. With an epidural, the needle stops short of piercing the sac surrounding the spinal cord, and the the medication is injected just outside the sac.

A spinal requires a smaller volume of medication and works faster than an epidural, but is more likely to cause a headache or low blood pressure.

Medication for a spinal is usually given as a one-time injection with a special needle. However, sometimes, if a lengthy procedure is planned or if considerable pain after surgery is foreseen, the healthcare professional may place a tiny tube into the sac around the spinal cord in place of the needle, and leave it there as a port to inject more medication during and shortly after the surgery.

The medicine stops the sensation of pain and paralyzes the muscles, usually only below the rib cage. The amount of medication given and the location of the injection in the back are important. These factors can control where the numbness and paralysis are in the body.

The individual is generally awake during the procedure. A sedatives can be given if the person is anxious. During a spinal, people usually breathe on their own without needing an artificial breathing machine (ventilator). Oxygen levels in the blood, blood pressure, pulse, and other functions are carefully monitored during and after the procedure. Fluids are usually given through an intravenous line (IV) to prevent dehydration and low blood pressure.

What happens right after the procedure?

A person is taken to an area called the surgery recovery room after the procedure. If sedatives were used, people may feel groggy for a few hours. Pain medication can be given if needed. The pain medication can be given through an IV or through the special tube in the spinal column if one is in place. The numbness and paralysis usually go away within a few hours.

The individual is usually asked to lie flat on his or her back for an hour or more after the procedure. This may help prevent problems with the injection site, and decrease the chance of headache. A short hospital stay may be needed to recover from major operations.

If not, a person may be able to go home later the same day in some cases. If sedatives were used, someone must drive the person home. The tube is taken out, and a person must usually be able to urinate before being allowed to go home. This lets the healthcare professional know that the medication has worn off.

What happens later at home?

A bandage is usually placed over the area on the back where the needle or tube was inserted. This should be left on for at least 24 hours. The area should not be disturbed. Little else needs to be done at home related to the spinal. Further home care may be needed related to the surgery that was performed.

What are the potential complications after the procedure?

The most feared complication of anesthesia is sudden death. This is thought to occur in roughly 1 out of every 10,000 people who have spinal anesthesia. It is not usually possible to predict who will have this type of severe reaction.

The most common problem after a spinal is a headache. This usually goes away within 24 hours. The headache often responds to pain medicine. Some people may need a repeat injection in the back to help the pain. Nausea is also fairly common for a few hours after the procedure. Blood pressure can get very low during the procedure, but this is usually of no consequence.

Allergic reactions and irregular heartbeats are rare complications of spinal anesthesia. Though often feared, nerve or spinal cord damage almost never occurs. Bleeding or infection can occur at the site of the needle injection. Other side effects may occur depending on the specific medicines used.

The American Society of Anesthesiologists recently issued a warning about the potential side effects and interactions of herbal remedies with medications used before, during, and after surgery. The group recommends discontinuing all herbal remedies and supplements at least two weeks before planned surgery.