When carrying out operations at the lower half of the trunk and lower limbs often used spinal anesthesia.This kind of reminds epidural analgesia, but differs from it by the injection site.Spinal anesthesia - a type of local anesthesia, which consists in the blockade of spinal nerves emerging from the spinal column.These nerves transmit sensory impulses from the receptors of the skin and soft tissues, as well as motor impulses to the muscles, providing them reduce and maintain the tone.How to choose anesthesia for surgery and how to make choices?
For spinal anesthesia, you should know what to choose anesthesia for the operation, a small amount of local anesthetic (about 3 mL) was injected into the subarachnoid space - a cavity surrounding the brain and spinal cord and contains the cerebrospinal fluid (cerebrospinal fluid).Operations on the lower half of the body can be carried out using this type of anesthesia, and the patient continues to stay awake.When combined with general anesthesia rachianesthesia
spinal anesthesia is usually used for carrying out:
• gynecological surgery, including removal of the uterus;
• transurethral resection of the prostate;
• orthopedic surgery of the lower limbs such as immobilization of femoral neck fracture when it is.
When epidural local anesthetic is injected into the epidural space, which surrounds the meninges of the spinal cord.It is located between the dura and the bony spinal canal.
Introduction anesthetic and how to choose anesthesia for surgery
For administration of the anesthetic needle is pushed a little deeper epidural space, piercing solid and arachnoid spinal cord and getting into the subarachnoid space.A lumbar puncture is done between the spinous processes II-V lumbar vertebrae.The spinal cord ends over this area, going into what is called a ponytail.Thus, at this point it is easier to reach the subarachnoid space.The diagnostic lumbar puncture to obtain a sample of cerebrospinal fluid for analysis in suspected meningitis is also produced in this area.The subarachnoid space is filled with cerebrospinal fluid.Unlike the epidural space, it has a much smaller volume.Therefore, for spinal anesthesia it requires much less drug.For effective anesthesia the abdomen and lower limbs of an adult enough about 3 ml of local anesthetic, which is 5-10 times smaller than in epidural anesthesia.
Spinal anesthesia has three glorious benefits is what to choose anesthesia for surgery:
• rapid onset of action and a strong analgesic effect.
Because the anesthetic is injected near the spinal nerves, spinal anesthesia begins to act much more quickly than an epidural, and has a more pronounced analgesic effect;
• to avoid general anesthesia.
Under certain conditions, such as diseases of the respiratory organs, the introduction of the patient's anesthesia is accompanied by a high risk of complications.In such cases the preferred application of spinal anesthesia whenever possible, for example, the operations in the lower half of the body.Pregnancy also refers to such states, and therefore in this case it is recommended to give up the use of general anesthesia.Fast action, high reliability and effective pain relief, as well as the possibility not to apply anesthesia allow the use of spinal anesthesia for elective and emergency caesarean section.However, all patients who are to surgery using this method of anesthesia, general anesthesia to be prepared in case the duration of the local anesthesia is not sufficient for the operation.In addition, in some cases, carried out simultaneously spinal and epidural anesthesia.The latter allows you to enter an additional dose of the drug on the time required to complete the operation;
• postoperative pain relief.
Spinal anesthesia is excellent relieves post-operative pain and avoids the systematic use of drugs based on morphine.Common side effects include a decrease in blood pressure, nausea, vomiting, itching, fever, muscle weakness, inability to urinate (usually in this case entered a urinary catheter).
Usually these symptoms disappear as soon as the end of the anesthetic.There are other possible complications.
• Headache after spinal anesthesia
Until recently, among the side effects of spinal anesthesia are often met the so-called spinal headache.Do not provoke a small leak of cerebrospinal fluid after puncturing the dura mater.Modern spinal puncture needles are designed such that they leave only a small hole in the dura.This minimizes the risk of leakage of cerebrospinal fluid, and therefore, the appearance of a headache.
• The duration of analgesic effect is achieved by a single administration of the anesthetic local anesthetic.The needle is then removed.Spinal anesthesia acts 2-3 hours.Being suitable for many surgical procedures, and in some cases it may not be enough deep for surgery or intervention may be delayed.In such cases often have to resort to a further general anesthesia.