PATIENT INFORMATION
Spinal and Epidural Anaesthesia
Anaesthetic techniques that temporarily numb part of the body by placing medication near the nerves of the spine.
Spinal and epidural anaesthesia can be used for certain operations, pain relief after surgery, labour pain or other specific pain-relief needs. They may be used on their own, with sedation, or together with general anaesthesia.
Temporary numbness
Medication blocks pain signals from part of the body for a period of time.
Often used below the waist
Spinals are commonly used for surgery involving the lower abdomen, pelvis or legs.
Can provide pain relief
Epidurals can also be used for continuous pain relief after surgery or during labour.
What does it do?
It numbs part of the body and can provide anaesthesia or pain relief.
Will I be awake?
You may be awake, lightly sedated, or have it combined with general anaesthesia.
How quickly does it work?
A spinal usually works within minutes. An epidural may take longer to reach full effect.
Why is it used?
It can allow surgery to proceed comfortably and may provide effective pain relief afterwards.
WATCH
Spinal anaesthesia explained
This video explains spinal anaesthesia and what patients may experience before, during and after the procedure.
Your anaesthesiologist will explain whether a spinal, epidural or another anaesthetic technique is most appropriate for your procedure.
OVERVIEW
What are spinal and epidural anaesthesia?
Spinal and epidural anaesthesia both involve placing local anaesthetic and sometimes other medication near the nerves of the spine. This temporarily blocks pain and produces numbness in the relevant area of the body.
They can be used to allow surgery to be performed comfortably, and they can also be used for pain relief after an operation, during labour, or in selected pain-management situations.
How they may be used
- As the main anaesthetic for certain operations
- Together with sedation for comfort and relaxation
- Together with general anaesthesia in some cases
- For pain relief after surgery or during labour
KEY DIFFERENCES
Spinal vs epidural: what is the difference?
Spinal anaesthesia
A spinal is usually a single injection of a small amount of local anaesthetic into the fluid surrounding the spinal nerves. It is commonly used for surgery involving the lower abdomen, pelvis or legs.
A spinal usually works quickly. As it takes effect, you may feel warmth, tingling, numbness and difficulty moving your legs. This weakness is temporary.
Epidural anaesthesia
An epidural involves placing a fine plastic tube, called an epidural catheter, into the space around the spinal nerves. Medication can then be given through the catheter without needing repeated injections.
Epidurals can be used for surgery, labour pain, pain relief after surgery or certain pain-management situations. The medication can often be adjusted depending on the level of numbness or pain relief needed.
PREPARING
Before your spinal or epidural
What your anaesthesiologist needs to know
- Previous anaesthetics, spinals or epidurals
- Allergies or reactions to medication
- Medical conditions and previous surgery
- Back problems or neurological symptoms
- All regular medication, including herbal products
- Blood-thinning medication or bleeding problems
- Diabetes medication
- Recent illness, fever or infection
Medication and fasting
Most regular medication may be continued, but blood-thinning medication and diabetes medication require special consideration. You should follow the instructions given by your anaesthesiologist or surgeon.
You may also receive fasting instructions, especially if sedation or general anaesthesia may be used. If you are unsure whether you may eat, drink or take medication, contact your surgeon or anaesthesiology team before doing so.
Blood-thinning medication is important
Please tell your anaesthesiologist about any medication or herbal products that may affect bleeding or blood clotting. This is especially important before a spinal or epidural because bleeding near the spinal nerves can be serious.
Do not stop prescribed blood-thinning medication unless your treating doctor, surgeon or anaesthesiologist has told you to do so.
ON THE DAY
What happens during the procedure?
Preparation
Your anaesthesiologist reviews your information and explains the plan.
Positioning
You may be asked to sit up or lie on your side so your back can be prepared.
Numbing the skin
Local anaesthetic is used to numb a small area of skin on your back.
Spinal or epidural
Medication is placed near the spinal nerves, or an epidural catheter is inserted.
Testing the block
Your anaesthesiologist checks that the numbness is suitable before surgery begins.
WHAT YOU MAY NOTICE
During and after the block
As a spinal or epidural takes effect, you may notice warmth, heaviness, numbness, tingling or temporary weakness in the affected area. If your legs are numb or weak, you should not get out of bed without assistance.
As normal sensation returns, you may become aware of discomfort from the operation. Ask for pain relief before the pain becomes severe.
Important aftercare
- Ask for help before getting out of bed
- Protect numb areas from pressure or injury
- Tell staff if pain is not controlled
- Let staff know if you cannot pass urine
- Report new weakness, numbness or severe headache
MORE DETAIL
Common questions and important information
Will I be awake during surgery?
You may be awake, lightly sedated, or have the spinal or epidural combined with general anaesthesia. Your anaesthesiologist will discuss the plan with you before the procedure.
If you are awake or sedated, a drape or screen is usually placed so that you do not see the operation.
How will the anaesthesiologist know it is working?
Your anaesthesiologist will test the numbness before surgery begins. This may be done using something cold, such as ice or cold spray, to confirm that the area is adequately numb.
Common temporary effects
- Low blood pressure or feeling lightheaded
- Nausea
- Shivering
- Itching
- Temporary numbness or weakness
- Difficulty passing urine
- Bruising or discomfort at the injection site
What is a spinal headache?
A spinal headache can occur if fluid around the spinal nerves leaks through a small puncture. It is uncommon, and most improve with rest, fluids and analegesic medication (e.g. paracetamol).
If it does not settle, further treatment may be offered. One treatment involves injecting a small amount of your own blood near the area to help seal the leak.
What if the block does not work fully?
In some cases, a spinal or epidural may not provide enough numbness or pain relief. If the surgery is not urgent, your anaesthetist may wait a little longer to allow the block more time to take effect.
If it is still not adequate, additional medication may be given through an epidural catheter, or a spinal anaesthetic may sometimes be repeated. If the block remains insufficient, or if surgery needs to proceed urgently, it may be necessary to change to a general anaesthetic.
Rare but serious complications
- Bleeding near the spinal nerves
- Infection
- Temporary or permanent nerve damage
- Very high or total spinal anaesthesia
- Severe allergic reaction
- Other extremely rare complications
Serious complications are uncommon when spinal or epidural anaesthesia is performed by a specialist anaesthesiologist, but no medical procedure is completely risk-free.
Can children have spinal or epidural anaesthesia?
Spinal and epidural techniques can be used safely in children in selected situations. The anaesthesiologist will consider the child’s age, health, procedure and pain-relief needs before recommending this.
When should I contact the hospital or anaesthesiology practice?
Contact the hospital, surgeon or anaesthesiology practice if you experience any of the following after a spinal or epidural:
- A severe or persistent headache, especially one that is worse when sitting or standing
- New or worsening back pain, buttock pain or leg pain
- Fever, chills, redness, swelling or discharge near the injection site
- New numbness, weakness or altered sensation in the legs, buttocks or abdomen
- Difficulty passing urine after discharge
- Loss of bladder or bowel control
- Pain that is not controlled by the prescribed medication
In an emergency, seek urgent medical care.
NEED HELP?
Still have questions?
Your anaesthesiologist will discuss the most appropriate anaesthetic and pain-relief options for your procedure.
