Spinal anesthesia: indications, method of conducting, side effects. Features of the spinal anesthesia what is called anesthesia in the spine

The advantages of this type of pain relief:

The amount of blood lost during blood surgery is reduced.
Less risk of developing such complications after surgerylike thrombosis, pulmonary thromboembolism.
Less, associated with the operation, unwanted effects and anesthesia on the heart and light.
No pain at the end of the operation.
No weakness, feelings of nausea, vomiting.
There are no such tough restrictions on the reception of beverages and food in the postoperative period.
When spinal anesthesia, you can communicate with anesthesiologist and surgeon before, during and after surgery.

At your request, an anesthesiologist can cause you a sinking condition by entering additionally medicines in Vienna. But we do not recommend using this opportunity.

Anesthesia - species of anesthesia

In modern medicine, two main types of anesthesia are used:

general - when the perception function of pain by the body is turned off in parallel with the patient's consciousness, that is, the patient is translated into artificial sleep;
epidural - with special manipulations "disconnect" sensitivity only on a certain portion of the body, and the person himself does not lose consciousness.

The spinal anesthesia is one of the varieties of epidural anesthesia. Most often it is used during childbirth.

Such a method helps to keep in the consciousness of the woman in labor, and the infant makes it possible to appear on their own. Such painkillers are used for cesarean sections and with simple childbirth, when a woman is difficult to cope with pain.

Preparations used in regional anesthesia

Anesthetic and his dose The doctor selects individually for each anesthesia, depending on the duration and nature of operational intervention. On average, 1-2 (ml) of the drug is used for each spinal cord segment, where it is necessary to be blocked.

The estimated dose of anesthetic is entered fractionally, for several receptions.

For reinforcing anesthesia, various kinds of anesthetics are used, which have different properties and provide different effects on the duration.

There are really many alternative options, and therefore, even if you are allergic to any drug, nothing to worry about what the doctor will definitely select a replacement.

Here is a brief list of medicines that are used with the method of anesthetic:

Naropin
Novocaine
Mesoth
Bulastan
Ropivakain
Fracinarin
Lidocaine
Noraderenalin
Bupivacaine (blockcase)

Preparation for the procedure and technique

Is it painful to do spinal anesthesia? The whole procedure lasts about 20 minutes and does not cause a patient unpleasant sensations. Cross in the back occurs painlessly.

The following contraindications for spinal anesthesia are distinguished:

Patient failure from such an anesthetic method.
No conditions for resuscitation.
Loss of a large amount of blood.
The presence of dehydration in the patient.
Reduced blood clotting. Treatment with drugs reduced blood coagulation.
Sispis (blood infection).
Infection of the skin in the place of the puncture.
Allergy to anesthetics.
Increased intracranial pressure.
Bradycardia (deceleration of the heart), heart rate disorders. Vices of the heart.
The aggravation of diseases caused by herpes virus.
Diseases of the central nervous system.
Hypoxia, malformations of the development and death of the fetus (with childbirth anesthesis).
No time for the procedure.

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Peridural anesthesia acts, creating a pharmacological blockade of spinal roots - one of the basic structural elements of the spinal cord. For this, special preparations of local anesthesia are used (Bupivacaine, Levobypivakain, Ropivakain), opiates (fentanyl, soufentanyl).

The anesthetic solution is introduced into the epidural space between the solid shell of the spinal cord and the vertebrae's periosteum, which makes it possible to block pain impulses of spinal roots.

To increase the duration, intensity of anesthesia, special substances are added to the solution of local anesthetic - vasoconstrictors that narrow blood vessels (ephedrine, phenylephrine, adrenaline).

Before conducting anesthesia, the doctor examines the patient, eliminating the problem in the lumbar region, skin diseases and other contraindications. Preparation includes blood test for hemoglobin, hematocrit.

This will help identify anemia, which can provoke a complication in the form of arterial hypotension - reduction of blood pressure. According to the testimony, a study is carried out by the magnitude of prothrombin time to make sure that normal blood coagulation.

Tip: The patient should know that epidural anesthesia can be carried out only in operating conditions, which will be equipped with equipment for monitoring its condition, resuscitation activities, general anesthesia.

How do epidural anesthesia make? Preparation includes skin treatment with antiseptics and the patient adoption of the desired posture (position lying on the side or sitting).

The doctor then palpates the ridges of the iliac bone and selects the area for puncture. When when needle passing, it ceases to feel resistance, it means that the epidural space is achieved.

If the doctor did everything right, there will be no pain.

The test dose of the local anesthetic solution is introduced and complemented by its drug for anesthesia or spend through the magnitude of the needle, a thin catheter for fractional (gradual) administration.

In place of its exit of the skin, it is fixed by adhesive plaster. Before the direct action of anesthesia is warm, numbness in the lower extremities.

It begins after a few minutes, and the duration of the effect can be adjusted by adding a new dose of drugs.

Tip: The patient has the full right to refuse precisely from this type of anesthesia, even if there is no contraindications. The argument can be a personal desire, an unpleasant experience, soreness of the procedure. Solution of local anesthetic is used to anesthestics

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Other complications

The use of epidural anesthesia carries less harm to the human body than in common.

But here the qualification of anesthesiologist is in many ways. The fact is that from how puncture will be performed correctly, not only the effect of anesthesia, but also its consequences.

In addition, it is still worth noting that the disease itself also plays the disease that will be eliminated by the Operal way. In addition, it is necessary to take into account:

the severity of the disease;
the age of the patient;
general health and human body;
there are secondary diseases, and what stage of development they are;
does the patient have bad habits, and what lifestyle he led before surgery.

But still before agreeing on the procedure, it is worth knowing what complications in spinal anesthesia may be:

After the surgery is completed, the patient will still feel nausea and headache. To get rid of such symptoms to get rid of this day, it is best to spend this day in bed and more drinking warm liquid.
Also in the first time, blood pressure indicators will be at low values. To eliminate this consequence, a patient again stands a lot of drinking fluid, and the doctor must put intravenously special drugs that increase pressure.
A few days after the operation, the place where the puncture was put, will still be sick, as such is not required for treatment, it is simply necessary to try to contact the item less with objects, for example, to sleep on the stomach if it is perverted.
Among men are found such a consequence as problems with urination. Usually such a problem passes after the day, as the operation ended.

Neurological disorders may be marked, which manifest themselves in the form of tingling on certain areas of the skin, or skin covers will partially lose their sensitivity.

The weakness of the muscles of the legs can also be noted. Just for the last reason, the women who passed the spinal puncture during childbirth, it is impossible to get up to the next 4 hours.

After all, standing with a child in his arms, they can simply sink their legs and they will damage the child.

Allergies may also appear.

But she makes itself felt in the event that the doctor improperly picked up an anesthetic solution for his patient.

Nevertheless, it is worth noting that all the above mentioned complications are not so heavy and with a timely reaction may already go literally after 1-2 days. But for the sake of justice it is necessary to specify the moment that such a method of anesthesia can cause more serious problems - bradycardia, spinal or epidural hematoma.

To date, two methods of anesthesia are used, which requires an injection in the back. For patients, this difference is not noticeable, but in fact there are many differences between them. lies in the following:

Anesthetics are introduced into different anatomical formations, in epidural and spinal space, respectively;
The rate of an anesthesia is also different. In epidural anesthesia, the anesthesia occurs after 20-30 minutes, and with a spinal after 5-10;
When performing a spinal anesthesia, a thin needle uses, and when performing epidural - thick;
The injection of spinal anesthesia is carried out exclusively in the lumbar spine, and with epidural it all depends on the required area of \u200b\u200banesthesia, and can be carried out in breast, lumbar, as well as in breast departments;
The depth of the injection with a spinal pain relief is greater than with epidural, since the spinal space is somewhat deeper;
Epidural anesthesia has less pronounced side reactions, as the anesthesia occurrence is longer. That is, the anesthesia comes gradually and the body has time to adapt to it and avoid unwanted consequences.

Also, an important difference is the fact that epidural anesthesia is used almost only in obstetrics, and the spinal has its own place in the gynecological, traumatological and surgical operations.

Indications for spinal anesthesia

Attention! The information on the site is represented by specialists, but is familiarized and cannot be used for independent treatments. Be sure to advise your doctor!

To date, spinal anesthesia is one of the most effective methods of anesthesia, used in operations at the bottom of the body. According to its principle, this method is similar to but somewhat different from it.

What is anesthesia

During the fulfillment of anesthesia, the doctor introduces the medicine directly in which allows you to block the nerves that are responsible for sensitive impulses. At the same time, the patient feels cold, coming from the spine to the legs, a little later, the bottom completely completely. The duration of the drug is up to 2 hours. Then move and sensitivity begin to recover.

Before performing the operation, ask what kinds of anesthesia are used in the hospital, and select the most suitable option. During operation with the use of spinal anesthesia, the patient is in wakefulness. However, the combination of general anesthesia with anesthesia will be stopped by postoperative pain.

Application

Spinal Anesthesia often use quite often during:

Gynecological operations, V.T.ch. When removing the uterus
Orthopedic operations
When immobilization or

Doctors during execution increasingly prefer precisely spinal anesthesia. The fever is in wakefulness, which favorably affects the general condition of the child. However, in some cases, doctors use an oxygen mask. If the patient feels discomfort, then an additional dose of intravenous analgesics is introduced, as a last resort, translated into common anesthesia.

Method of execution

The procedure for administering the drug is performed in two ways. The patient sits onto the edge of the operating table and, leaning in his knees, leans forward. You can enter the tool and lying. The patient is placed on the left side, and offer to bend the knees and hips as much as possible. Regardless of the selected method, the doctor tries to achieve the most bent back.

Contraindications

The main contraindications to the performance of spinal anesthesia are:

Patient's written failure
Increased intracranial pressure
Hypoxia fruit
Cardic impairment, heart defects
SPEPSIS
Blood coagulation disorders
Dehydration or blood loss
CNS diseases (central nervous system)
Future defects
Fruit death
Urgency
Lack of necessary conditions
Allergic reactions to analgesics
Skin infection

Advantages and disadvantages

Spinal anesthesia has several significant advantages that significantly distinguish it from other types of anesthesia.

Saving postoperative pain. This circumstance eliminates the additional administration of morphine-based drugs.
Speed. The medicine is administered directly in therefore it is much more effective, and the action begins much faster than in epidural anesthesia.

In addition to the advantages, it has its own flaws to which:

A sharp decline in pressure. It occurs as a result of and arterilation dialing. In this case, the raising of the legs contributes to the restoration of blood flow and normalization of pressure.
Headache can manifest a long time (up to 4 days after surgery).
Nausea is the main side effect caused by hypoxia, bardicardium and hypotension.
Backache. This circumstance can be caused by tensioning ligaments, suspended injury or long stay on the hard operating table. Usually pain passes on the second day.
Reduced hearing is mainly due to the use of larger needles (27 g). The complication is weakly pronounced and non-plum, but may bring serious concern to some patients.

Spinal anesthesia, the consequences of which are not a critical-effective way of anesthesia during surgery. It is almost safe, perfectly relaxes the abdominal press and effectively relieves pain. The lack of a negative impact on the fruit make it possible to use this anesthesia even with obstetric operations. Spinal anesthesia plays a key role in performing operations at the bottom of the body.

Spinal anesthesia, what is it? What exactly lies under this title? Spinal, or spinal anesthesia is a regional anesthetic method that provides a complete absence of any sensations in the lower body and serves as an excellent alternative to the general anesthesia. By the way, if you dial in the search bar "What is a spinal anesthesia", then the information that will be given to you will sanctifies the spinal anesthesia, as the anesthesia can be only common, with a full disconnection of consciousness, while the anesthesia does not possesses. But, nevertheless, this method of anesthesia is sometimes called spinal anesthesia, in addition he has a number of synonyms. Here they are:

The principle of action of spinal anesthesia

In order to provide a person sufficient anesthesia at the same time, the anesthetic method is introduced into the subarachnoid space (the cavity between the shells of the head and spinal cord). This space is filled with the spinal fluid, it is called the liquor. Finding into the right place, anesthetic blocks the transfer of any sensations from the roots of the spinal nerves to the brain and thereby achieved the complete absence of sensitivity at the bottom of the patient's body.

TECHNOLOGY OF EVERYONMENT

The technique of conducting spinal anesthesia is a rather complicated process that requires a certain share of skill. In addition, for spinal anesthesia requires a special set of tools, which allows to a minimum to reduce the risk of developing complications in the future.

This is how the preparation of a workplace for spinal anesthesia occurs. The doctor prepares the necessary tools that he will need. The list includes:

Alcohol tampons (to comply with the rules of asepsis and antiseptics)
Two syringes: with local painkillers to make the puncture process more comfortable for the patient, as well as directly with an analgizing agent, which will be introduced into the subarachnoid space.
The puncture needle is significantly different from the one that is used, for example, for carrying out - it is more subtle. Ideally, the needle must be a special, so-called "pencil" sharpening.

But how to prepare for a spinal anesthesia:

Watch the video where it is shown how they make spinal anesthesia, you can on our website.

Preparations for spinal anesthesia

For carrying towing anesthesia, various kinds are used, which have different properties and give a different effect on the duration. There are really many alternative options, and therefore, even if you are allergic to any drug, nothing to worry about what the doctor will definitely select a replacement.

Here is a brief list of medicines that are used with the method of anesthetic:

Naropin
Novocaine
Mesoth
Bulastan
Ropivakain
Fracinarin
Lidocaine
Noraderenalin
Bupivacaine (blockcase)

Positive and negative sides of the method

We offer to familiarize yourself with all the advantages and minuses of spinal anesthesia (anesthesia) to decide whether it is worth it to make a spinal anesthesia.

pros

Minuses

During the reinforcement method of anesthesia, as a rule, the patient drops sharply pressure. This fact may be both a plus for people with elevated blood pressure, as well as a significant minus for patients with reduced. To prevent complications that may be associated with this nuance, the patient before the operation is introduced by drugs. Of course, if there is a need for it.
The anesthesia time is limited by the amount and dosage of the introduced drug. Unlike the epidural, where the duration of action can be constantly maintained, here, if the effect of the medication ends, the patient is urgently transferred to common anesthesia. However, in modern medicine there are anesthetics of long-term action, the effect of which lasts up to 6 hours.
As a side effect, the development of neurotic complications is possible, the most common of which is.

Indications and Contraindications for use

Indications

Package of the process of fights in childbirth or holding a "cesarean section"
Almost any operational interventions performed below the navel level
Operations in gynecology and urology
Surgical intervention conducted on the legs, for example, treatment of varicose
Operations in the crotch area
Weightful indication for the use of spinal anesthesia is the intolerance to the general anesthesia. This may be associated with older age, allergic reactions, as well as with somatic pathologies in the patient.

Contraindications are divided into two subgroups

Absolute(in which the method does not apply in any case)

Categorical failure of the patient
Bad blood clotting and application before the operation of anticoagulants (in this case, the risk of strong bleeding is too high, and, as a result, significant blood loss)
Inflammation and infection in the place where puncture must be performed
The patient's condition of significant gravity (severe blood loss, shock condition, cardiac and pulmonary failure, sepsis)
Allergic reactions to all groups of anesthetics that can be used during spinal
Infectious diseases of the nervous system, such as, for example, meningitis
Intracranial hypertension
Herpes
Extremely severe degree of cardiac arrhythmia

Relative (The method is applied if the benefits of its conduct greatly exceeds harm)

Deformation of the spine, congenital or occurring by the suffered injury
Predicted significant blood loss during operational intervention
Infectious diseases accompanied by an increase in body temperature, fever
Diseases of the nervous system (epilepsy, multiple sclerosis and others)
The patient is morally unstable or has some mental deviations (there is a risk that he will not be able to lie calmly for time while the operation lasts)
Application on the eve of a medicine such as aspirin (this medicine increases the risk of bleeding)
The surgeon suggests that the operation time may be longer than planned at the beginning. It happens, for example, when removing tumors. Surgeon evaluates the situation in accordance with the intervention seen during the intervention
Childhood

Complications

The most common complication is the postpunction headache, which arises due to the influence of the spinal fluid (liquor) during the execution of the puncture
Toxic effect of anesthetics (influence on internal organs)
Epidural hemorrhage
Risk of infections
Difficulty with urination
Strong pain in the injection
Injuries of the spinal roots and spinal cord fabrics arising because of the wrong method of conducting puncture

Restoration

Of course, the recovery process will depend not as much from the anesthesia itself, as from the complexity of the operation. But if it comes to an exclusively spinal, then what should be waiting:

The restoration of the sensitivity of the lower half of the body usually occurs after 1-4 hours. This aspect depends on what analgesizing drug will choose a doctor.
The patient's position after the reinforcement anesthesia should be strictly horizontal. This is also due to remove the symptoms of the after-section headache, if such manifested
Stand on your feet will be permissible on the outcome of the first day after the anesthesia. Ask help from medical staff, since dizziness is possible
In about half an hour - an hour you can drink water, but the food is only on the expiration of several hours, for example, in the evening if the operation was carried out in the morning. Food should be easily assimilated.

Spinal anesthesia - method selected with many operational interventions carried out below the navel. This kind of pain relief is best suited for elderly people who have chronic obstructive lung disease, endocrine, renal disorders.

Indications for sa:

Operation below the navel level;

Surgical intervention on the crotch;

Cesarean section;

Operations on the lower limbs, except amputation;

Gynecological and urological operations.

Contraindications:

Patient failure;

Blood coagulation disorders;

Infection at the point of puncture;

Heart ventilation;

Peripheral neuropathy;

Multiple sclerosis;

Spinal deformation;

Septis, meningitis.

Spinal anesthesia: preparation for conducting

Preparation lies in a conversation with the patient and receiving consent to the procedure. Immediately before anesthesia, premedication is carried out.

Set for spiral blockade:

Spinal needle with conductor (inverter);

Syringe for painting the place of puncture;

Syringe for intrathecal anesthesia;

Sterile gloves, alcohol, wool, gauze ball and plaster;

Anesthetic ("Marcain", "Bupivakain", "Lidokain").

Spinal anesthesia: patient position

Use two main positions:

Lying on the side. The position is used most often in anesthesiological practice. The patient should be bent so much as he can do it: the knees should be pressed against the body, and the chin - to the chest. The patient's back should be on the edge of the operating table.
In a sitting position. The patient sits on the edge of the operating table, the legs must be located on the stand. The torso is bent as much as possible, the chin should touch the chest, and the hands are crossed on the stomach.

Spinal anesthesia: execution technique

Plot puncture is treated with ethyl alcohol. Then wipe the dry marlevary napkin. After that, a local anesthetic for surface pain relief is introduced at the site of the alleged injection. Next, the needle for neuroaxial anesthesia makes puncture and on the middle line it is promoted to the spine. Promote until the assistant feel the failure, after removing the introduction, the spinal fluid should appear. As soon as possible joins the needle of a syringe with anesthetic, which is slowly injected in the spinal cord. After an anesthetic is introduced, the needle is taken together with the syringe and put a sterile gauze bandage at the point of puncture, fixing it with a plaster.

Spinal anesthesia. Complications:

Arterial hypotension and reduction of heart rate (bradycardia);

Respiratory disorders (apnea);

Epidural abscess, meningitis;

Traumatic damage to the spinal cord;

Epidural hematoma;

Neurotoxic disorders (toxic action of local anesthetic on nerve fibers);

Ischemic disorders arise in the case of applying adrenaline as an adjuvant;

Postpunction syndrome.

Spinal anesthesia: consequences

Frequently distant consequences of intrathecal anesthesia is postpunction headache. The reason is the expiration of the cerebrospinal fluid through a solid brain shell into epidural space. The consequence of such a process is not only pronounced headache, but also nausea, vomiting, dizziness. In order to prevent such phenomena, the operator must be used for neuroaxial anesthesia thin needles 25-27 G. In the event of such consequences of anesthesia, immediate treatment begins. It lies in constant bed mode, infusion therapy in a volume of up to two liters per day, abundant drinking, the use of caffeine and non-steroidal anti-inflammatory drugs. Headache can last from 10 to 14 days.