Spinal anaesthesia

Spinal block is typically used to facilitate operative interventions. A fine-gauge spinal needle is used to puncture the dura in order to deliver an intrathecal dose of local anaesthetic, usually combined with an opioid.

Onset of anaesthesia is much more rapid than with epidural anaesthesia and is often accompanied by turbulent haemodynamic changes which can cause significant hypotension and consequent nausea and vomiting. The injected local anaesthetic mixture is typically denser than cerebrospinal fluid (CSF), allowing manipulation of the height of the block by applying Trendelenburg or reverse-Trendelenburg positioning to the patient. The patient may experience residual block for up to 6 hours after injection. A combined spinal and epidural injection allows a ‘low-dose' spinal injection to be performed in combination with the placement of an epidural catheter to provide rapid pain relief in labour. It can also be used for operative interventions in theatre instead of a single-shot spinal.

Contraindications are the same as for epidural injection, but in addition may include any clinical scenario where there is already haemodynamic instability such as massive obstetric haemorrhage or maternal sepsis. In these situations, the patient must be resuscitated and stabilized first if time allows. If time is critical and full-volume resuscitation is not possible, then a spinal blockade is relatively contraindicated and general anaesthesia may be necessary.

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Source: Arulkumaran S., Ledger W., Denny L., Doumouchtsis S. (eds.). Oxford Textbook of Obstetrics and Gynaecology. Oxford University Press,2020. — 928 p.. 2020

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Spinal anaesthesia

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