Meet The Team
Spinal Anaesthesia
This page provides important information about spinal anaesthesia, a common method used during a caesarean section (C-section). Understanding this procedure can help alleviate concerns and prepare you for your upcoming surgery.
What Is Spinal Anaesthesia?
Spinal anaesthesia involves the injection of a local anaesthetic with or without an adjuvant opioid into the spinal fluid in your lower back. This blocks sensation and movement from the waist down, allowing you to remain awake and aware during the birth of your baby while ensuring you feel no pain.
Why is Spinal anaesthesia used?
Spinal anaesthesia is preferred for C-sections due to its effectiveness in providing rapid pain relief, allowing for a calm and controlled surgical environment. Being awake and aware allows you to participate in the birth experience. It is usually the safest option for both mother and baby unless there is a specific contra-indication.
Pre-operative consultation
Your anaesthetist will meet you in the ward or the theatre reception area before your procedure. A medical history will be obtained, and a physical examination performed. During this visit, the anaesthetist will determine if spinal anaesthesia is safe for you and discuss the procedure and relevant side effects or possible complications. Please inform the anaesthetist of any medical illnesses and chronic medication you take. It is vitally important to mention any bleeding disorders or if you are taking a blood-thinning drug such as Warfarin, Aspirin, Ecotrin, Pradaxa, Clexane or any others.
The Procedure
Preparation
You will be taken to the operating room where you will be asked to sit up or lie on your side. An intravenous cannula (drip) will be inserted to allow fluid or medication to be administered.
Sterilization
Your lower back will be cleaned with an antiseptic solution.
Local anaesthetic
A small dose of local anaesthetic will be injected into the skin at the site of the spinal injection to numb it.
Injection
Using a fine needle, the anaesthetist injects local anaesthetic into the lower back, through the dural layer, into the subarachnoid space and fluid surrounding the spinal cord. This then temporarily numbs the nerves responsible for the sensation of pain during surgery as well as the motor nerves that allow movement.
Monitoring
Your vital signs will be continuously monitored throughout the procedure.
Preparing for surgery
After the spinal injection is completed, you will be asked to lie on your back and your hip will be slightly wedged to ensure your uterus doesn’t compress the large blood vessels in your abdomen. Your buttocks and legs might start to feel warm and tingly, followed by a heavy feeling in your lower body. It may take 10-15 minutes before the spinal block takes full effect. The surgical staff will prepare by placing a urinary catheter in your bladder. Then your abdomen will be cleaned and draped. The anaesthetist will test that the spinal is working adequately before surgery starts.
Surgery
Your anaesthetist will stay at your side throughout the procedure and talk you through the process. You should not experience pain during the procedure, but you might feel sensations of touch, pressure and movement in your abdomen. Once your baby is born, a paediatrician will examine them in the operating room to make sure all is well before placing your baby on your chest as soon as possible.
Partner
One birthing partner is allowed to be with you in the theatre and is encouraged. Some hospitals might allow your doula to be present as well.
Recovery
Once your surgery is completed, you will be transferred to a recovery area where nursing staff will monitor you for a further 30-45 minutes to ensure all is well before you return to the ward. The obstetric staff will help your baby latch and breastfeed if that is your wish.
Postoperative pain management
Your anaesthetist will discuss pain management options. Usually, a combination of simple analgesics such as Paracetamol and anti-inflammatory drugs are used in conjunction with opioids. The best routes of administration and possible side effects will be discussed.
When not to have spinal anesthesia
Patient refusal
The patient must consent to the procedure.
Local infection or sepsis
Infections at the injection site can spread to the central nervous system.
Severe systemic sepsis
Bleeding disorders or anticoagulant therapy
Conditions like hemophilia or use of blood thinners increase the risk of spinal hematoma.
Severe aortic stenosis
This can lead to significant drops in blood pressure.
Increased intracranial pressure
or space-occupying lesions in the brain.
Allergies
to any of the drugs that will be administered.
Dehydration
Severe dehydration, or hypovolemia, can increase the risk of hypotension.
Other conditions
Other relative contraindications include spinal stenosis, previous spinal surgery, multiple sclerosis, spina bifida, aortic stenosis, and fixed cardiac output.
Risks and Side Effects
Common
- Low Blood Pressure: This occurs commonly due to blockade of nerves that control the tone in blood vessels. Your anaesthetist will monitor your blood pressure closely and manage it with appropriate drugs and intravenous fluids
- Nausea and vomiting
- Shivering
- Urinary Retention: Spinal anaesthesia can temporarily affect bladder function, leading to difficulty urinating. This typically resolves on its own after the anaesthetic wears off. You will have a urinary catheter placed.
- Anxiety: Some patients may experience anxiety or panic during the procedure, especially if they feel confined or unable to move. Communication with the medical team can help alleviate these feelings.
Uncommon / Rare
- Headache: A post-dural puncture headache may develop a few days after the procedure. Please alert your medical team if you develop a headache that gets worse when you are upright.
- Bleeding: Please alert your anaesthetist if you are on any medications that might affect your blood clotting such as aspirin, Warfarin, Xarelto or Plavix. Spinal haematomas are a very rare complication of spinal injections.
- Infection: Any injection into the body carries a risk of infection. Though rare, an infection at the injection site or in the spinal fluid (meningitis) can occur. The medical team will use sterile techniques to minimize this risk.
- Nerve Damage: While extremely rare, spinal anaesthesia can cause temporary or, in very rare cases, permanent nerve damage. This may lead to sensory or motor deficits in your lower limbs.
- Incomplete Blockade: In some cases, the anaesthesia may not provide complete pain relief, leading to discomfort during the procedure. This can sometimes be addressed by additional medication or techniques. In rare cases, conversion to a general anaesthetic may be required.
- Allergic Reactions: Though uncommon, some individuals may have allergic reactions to the local anaesthetic agents used in spinal anaesthesia. Symptoms can range from mild (itching, rash) to severe (anaphylaxis).
While spinal anaesthesia is generally safe and commonly used for C-sections, it is important to be aware of these potential risks. Discuss any concerns or pre-existing conditions with your healthcare provider to ensure you receive the safest and most effective care tailored to your needs. Remember that your medical team will monitor you closely throughout the procedure to manage any complications should they arise.