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Regional spinal anesthesia

Spinal anesthesia

Spinal anesthesia permits painless surgery below the navel. The anesthetic agent is administered into the so-called spinal cavity (the bone marrow cavity filled with endoneurial fluid at the level of the lumbar spine). The pain-conducting nerve fibers at this site are anesthetized and thus the sensation of pain in the operative field is blocked. The effect persists for at least 60-180 minutes.

Procedure:
  • You will sit on the surgical table (straight base); your hip, knee and ankle joints will be at right angles (the feet are placed on a stool)
  • The injection site is between the 3rd and 4th lumbar vertebra. This area will be washed with disinfectant and covered with sterile drapes
  • You will then be given a local anesthetic in the region of the injection site
  • A thin cannula will be introduced into the intervertebral space
  • Once the spinal cavity (the space of endoneurial fluid) has been reached, a specific quantity of a local anesthetic will be administered
  • The cannula will be completely removed along with the guiding tube
  • The injection site will be covered with a sterile plaster
  • You will be returned to supine position
  • You will feel a sensation of warmth on your buttocks and legs, and will be unable to move these body parts or will be able to move them to a limited extent
  • You will be entirely free of pain, but awake and responsive. However, if you wish you can also be given a sedative or a tranquilizer, which will make you sleepy
  • The effect will abate after 2-3 hours; your sensation and mobility will return slowly
Side effects/Complications

Spinal anesthesia is a very safe and widespread procedure. Nevertheless, a variety of rare undesirable effects may occur, such as:
  • An allergic reaction to local anesthetics,
  • A drop in blood pressure (usually very mild and not requiring treatment)
  • Rather severe headache or back pain
  • Urinary retention
Direct injuries to the spinal cord are largely ruled out because the spinal cord in adults terminates above the injection site. Nerve lesions or nerve compression due to bleeding may, in extremely rare cases, cause a permanent functional disorder in the concerned nerve or even paraplegia.

In rare cases a person may experience discomfort after regional anesthesia. During the entire operation and postoperatively in the recovery room, you will be monitored continuously by your anesthetist and our anesthesia nursing staff - as we do after general anesthesia as well.

At a personal informative consultation before the operation we will inform you about the potential risks.

Contraindications
  • Coagulation disorders
  • Infections or tumors at the injection site
  • Low blood pressure or shock
  • Severe congenital cardiac defect
Epidural anesthesia

Epidural anesthesia permits painless surgery in the upper body (chest and lungs), major abdominal surgery (stomach, intestines, abdominal aorta, uterus), urological interventions (prostate, kidney, etc.) and the legs. Epidural anesthesia is usually administered in combination with general anesthesia. The anesthetic agent is administered to a specific region of the spinal canal through a very thin and flexible synthetic tube (epidural catheter). It inhibits nerve conduction at the respective site. As you will be entirely free of pain in the operative field, the anesthesia will be much more gentle and you will recover rapidly after the operation.

The epidural catheter permits very effective postoperative pain treatment (pain therapy). You will have no pain after the operation, will be able to move freely, and will have a demonstrably lower risk of complications like pneumonia, thrombosis, postoperative intestinal obstruction, etc.

Procedure for epidural anesthesia:
  • You will sit on an operating table (straight surface); the hip, knee and ankle joints will be at right angles (the feet will be placed on a stool) and you will be asked to arch your back
  • The injection site is between two vertebrae in the thoracic or lumbar spine. This region will be washed with a disinfectant and covered with sterile drapes
  • You will then be given a local anesthetic in the region of the injection site
  • A special cannula will be introduced into the intervertebral space
  • After reaching the epidural space, the catheter will be introduced
  • The cannula will be removed and the injection site or the site of catheter insertion will be covered with a sterile plaster
  • You will be returned to supine position
  • After the operation a pump will be connected to the catheter, through which analgesic medication will be administered continuously
  • If necessary, additional doses can be given through a bolus administration device
Side effects/Complications

Epidural anesthesia is a very safe and widespread procedure. Rare side effects are the following:
  • Allergic reaction to local anesthetics
  • Injury to blood vessels or nerves, followed by neurological symptoms
  • A drop in blood pressure (usually mild and not requiring treatment)
  • Infection
  • Rather severe headache or back pain
Nerve lesions or nerve compression due to bleeding are extremely rare. In isolated cases it may lead to a permanent functional disorder of the injured nerve or even paraplegia. In rare cases a person may experience discomfort after regional anesthesia. During the entire operation and postoperatively in the recovery room, you will be monitored continuously by your anesthetist and our anesthesia nursing staff - as we do after general anesthesia as well.

At a personal informative consultation before the operation we will inform you about the special risks.

Contraindications
  • Coagulation disorders
  • Infections or tumors at the injection site
  • Low blood pressure or shock
Severe congenital cardiac defect