Spinal Anesthesia And Epidural Anesthesia: Indications, Contraindications, Technique And Complications

Spinal Anesthesia

Indications

It is targeting the lower abdomen and lower limbs, so it can be used in surgeries in lower abdominal and lower limbs. It blocks the sensory and motor neurons, so no pain and no move. If the surgery in the lower part of the body, we can use in place of general anesthesia. The patient will be awake, but he can not feel about anything and can not move anything in his lower body. It is best choice in this surgery, because we can avoid the multi drugs and the complications of general anesthesia.

Contraindications

There are somethings prevent us from using this type of anesthesia. First, patient choice. If the patient asks not to use spinal anesthesia, we have to respect his right and use another type which is local or general. Second, if the patient has infection that maybe show complications if we use this type. If the patient bleed or we expect him to bleed we have to go to general anesthesia. If the patient has allergy to medications for spinal anesthesia, we have to avoid it.

Technique

First, we have to make sure that the needle will be inserted lower then L2 in adults and L3 in pediatrics, so we can avoid the spine. We can find L4 body by Line across iliac crests, so we can sure that we lower than L2. First, we have to sterile the area. than we insert the needle slowly until we rich the CSF. Then, we can inject the medication.

Position

We have tow positions letteral and sitting position.

Letteral: the patient will be sleep in his left or right side and his back will be curved.

Sitting: the patient will be sitting and his back will be curved forward.

Complications:

• Hypotension
• low cardiac output
• hypovolemia
• headache.

Epidural Anesthesia

Indications

Epidural anesthesia targets the sensory nerves, but not motor. So, the patient can move, but he can not feel. They probably use when they need the patient move or push like in Labor cases. Sometimes, they use it combined with general anesthesia probably for postoperatively purposes like thoracic surgeries. Because of the pain, the patient can not breath, so they will use to relief the pain, so the patient can breath easily.

Contraindications

If the patient refuse.- If there is infection in the site.- bleeding.

Technique

We can do the epidural anesthesia anywhere in the epidural from neck to L5. We insert it and we check by using the cannula if there is no resistance we are in the epidural space. We have to change it every 5 day to avoid infection.

Position: Same in spinal anesthesia letteral and sitting position.

Complications:

• Hypotension.
• Headache.
• Transient backache.
• Urinary retention.
• Neurological damage.
• Infection.