Spinal Anesthesia-Indications and Contradictions
Spinal anaesthesia is a commonly used technique, either on its own or in combination with sedation or general anaesthesia. It is most commonly used for surgeries below the umbilicus, however recently its uses have extended to some surgeries above the umbilicus as well as for postoperative analgesia. Procedures which use spinal anesthesia include:
- Orthopaedic surgery on the pelvis, hip, femur, knee, tibia, and ankle, including arthroplasty and joint replacement
- Vascular surgery on the legs
- Endovascular aortic aneurysm repair
- Hernia (inguinal or epigastric)
- Nephrectomy and cystectomy in combination with general anaesthesia
- Transurethral resection of the prostate and transurethral resection of bladder tumours
- Hysterectomy in different techniques used
- Caesarean sections
- Pain management during vaginal birth and delivery
- Urology cases
- Examinations under anaesthesia
Spinal anaesthesia is the technique of choice for Caesarean section as it avoids a general anaesthetic and the risk of failed intubation (which is probably a lot lower than the widely quoted 1 in 250 in pregnant women). It also means the mother is conscious and the partner is able to be present at the birth of the child. The post-operative analgesia from intrathecal opioids in addition to non-steroidal anti-inflammatory drugs is also good.
Spinal anesthesia is a favourable alternative, when the surgical site is amenable to spinal blockade, for patients with severe respiratory disease such as COPD as it avoids potential respiratory consequences of intubation and ventilation. It may also be useful, when the surgical site is amenable to spinal blockade, in patients where anatomical abnormalities may make tracheal intubation very difficult.
In pediatric patients, spinal anesthesia is particularly useful in children with difficult airways and those who have are poor candidates for endotracheal anesthesia such as increased respiratory risks or presence of full stomach.
This can also be used to effectively treat and prevent pain following surgery, particularly thoracic, abdominal pelvic, and lower extremity orthopaedic procedures.
Prior to receiving spinal anesthesia, it is important to provide a thorough medical evaluation to ensure there are no absolute contraindications and to minimize risks and complications. Although contraindications are rare, below are some of them:
- Patient refusal
- Local infection or sepsis at the site of injection
- Bleeding disorders, thrombocytopaenia, or systemic anticoagulation (secondary to an increased risk of a spinal epidural hematoma)
- Severe aortic stenosis
- Increased intracranial pressure
- Space occupying lesions of the brain
- Anatomical disorders of the spine
- Hypovolaemia e.g. following massive haemorrhage, including in obstetric patients
- Ehlers Danlos Syndrome, or other disorders causing resistance to local anesthesia
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