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© The State of Queensland (Queensland Health) 2017 Except as permitted under the Copyright Act 1968, no part of this work may be ÌSWPIÇ~a;Î reproduced communicated or adapted without permission from Queensland Health To request permission email: [email protected] SWPI9465 Source of images 1 & 2: Royal College of Anaesthetists Department of Health • • • • • • • include: anaesthetic compared to ageneral anaesthetic The advantages of anepidural and/orspinal spinal anaesthetic 2. Potential benefits of anepidural or will discuss this with you before theoperation. given ageneral anaesthetic. Your anaesthetist you may befully awake, sedated oralso be During your epidural and/orspinal anaesthetic anaesthetic’ or‘regional block’. nerve anaesthetics are also atypeof ‘regional both are given together. Epidural andspinal different types of anaesthetic andsometimes Epidural andspinal anaesthetics are similar but anaesthetic. comfortable for you than having ageneral or spinal anaesthetic may besafer ormore operation you are having, anepidural and/ Depending on your medical condition andthe from reaching your brain. medicine works by blocking thepain signals that prolongs pain relief for many hours. The medicine may beinjected at thesame time impossible to move your legs as normal. Other longer. During this timeit will bedifficult or your body for oneto four hours andsometimes the nerves supplying thelower part/half of the middle of your lower back. This can numb through aneedle and/orthinplastic tubing into body, local anaesthetic medicine is injected For someoperations onthelower half of the anaesthetic and how will it helpme? 1. What is aspinal orepidural healthcare professional. spinal anaesthesia. It has beendeveloped to beused indiscussion with your doctor or This information sheet answers frequently asked questions about having epidural and operation, especially if you are anolder person less risk of becoming confused after the surgery quicker return to drinking andeating after less sickness and vomiting confusion, drowsiness, andconstipation and theirside effects, including nausea, less needfor strong pain-relieving medicines, excellent pain relief immediately aftersurgery less effect onthelungs andbreathing less risk of achest infection aftersurgery

Epidural andspinal anaesthesia Epidural and spinal anaesthesia patient information include: Common side effects andcomplications problems. temporary, someof themmay cause long-term and complications. Whilst these are usually Every anaesthetic has arisk of side effects 3. What are therisks of theanaesthetic? • • • spinal anaesthetic 2. Potential benefits of anepidural or • • • • • • • partner can bewith you. amounts of any medications given and your are born, thebaby will only get incredibly small will beable to see your baby as soonas they if you are having acaesarean sectionbirth, you improved blood flow after vascular surgery improved bowel recovery afterbowel surgery – – headache: – – – pain during theinjection: – – problems inpassing urine(urinary retention): – – itching: shivering nauseaand vomiting – – low blood pressure: medicines hours and can betreated with pain relieving most headaches get better within afew dehydrated, not eating andanxiety operation, including theanaesthetic, being there are many causes of headache afteran the needle may needto berepositioned might bedueto theneedle touching anerve the pain might bein your legs orbottom and pain inplaces otherthan where theneedle is immediately tell your anaesthetist if you feel bowel function is not affected and for timeafterwards ashort your bladder while theanaesthetic wears off you may require acatheter to beplaced in treated inform thestaff if you are itchy—it can be the anaesthetic is aside effect of someof themedications in into youryourdrip vein with fluids andmedications given through the anaesthetist can treat low blood pressure this can make you feel faint orsick Informed consent: patient information (continued) v3.00 09/2017 Page 1 of 5

Department of Health • • • • • • • • • Rare side effects andcomplications include: • • • • • • include: Uncommon side effects andcomplications • • • • • anaesthetic? 3. What are therisks of having an – – damage:temporary nerve – – – – – severe headache: chest infection. prolonged numbness ortingling aches andpains (usually temporary) pain and tenderness at theinjection site – bruising (haematoma) at theinjection site: leaking of stomach content into thelungs them) catheters possibly requiring surgery to remove equipment failure (e.g. breakage of needles or serious allergic reaction blood clot with spinal cord damage double vision termshort deafness antibiotics treatment andfurther epidural catheter; epidural abscess) requiring infection (e.g. around injection site and paralysing the breathing muscles higher than planned andaffect breathing by severe breathing difficulty: the block may go general anaesthetic occurring as major complications of having a paralysis: it has about thesame chance of permanent damage nerve with possible existing medical problems getting worse. allergic reaction method of anaesthesia to beused require anaesthetic further and/oradifferent the anaesthetic does not fully work: this may breathing: theanaesthetist can treat this overdose of medicines which may lead to slow may last for afew days, weeks ormonths the lower body needles andsometimes muscle weakness in temporary loss of sensation, pins and GP orby attending theemergency department anaesthetist for anassessment and/or thesurgical team will contact your if you are still inhospital, your nurses you will needto see ananaesthetist improves if you liedown it will get worse onsitting orstanding and can occur afteraspinal injection affect your blood clotting more likely to get ahaematoma as it may if you take blood thinning medicines you are if you have left hospital, seek helpfrom your (continued)

Epidural and spinal anaesthesia patient information • training whowill: Your anaesthetist is adoctor with specialist 6. What does my anaesthetist do? these with your doctor/healthcare professional. have theproposed anaesthetic. Please discuss There may beconsequences if you choose not to proposed anaesthetic? 5. What are therisks of not having the consent form before you sign it. these with you. Ensure they are written onthe doctor/healthcare professional will discuss individual condition andcircumstances. Your There may also berisks specific to your 4. What are my specific risks? • • • • anaesthetic? 3. What are therisks of having an injections are doneina very clean (sterile) way. they want you to do. Just like anoperation, the The anaesthetist andtheteam will explain what on your side, onthetrolley oroperating table. injection into your back eithersitting, orlying You will normally have theepidural orspinal hand orlower arm. always put into oneof your veins, usually in your known as acannula, intravenous fluids orIV) is Before theprocedure commences, a‘drip’(also procedure? 7. What happens during my anaesthetic according to relevant professional guidelines. training.further All trainees are supervised healthcare professional/student undergoing (particularly inrural areas) oradoctor/ anaesthetist, aGPwith training inanaesthetics You may beseenandcared for by aspecialist • • • • assess your health andthendiscuss with severe harm ordeath (veryrare). cardiac arrest meningitis seizures (convulsions orfits) manage blood transfusions if required. after your surgery orprocedure caring for you during your surgery andstraight be responsible for giving your anaesthetic and and pain control agree to aplan with you for your anaesthetic options discuss therisks of suitable anaesthetic surgery orprocedure you thetypeof anaesthetic suitable for your (continued) v3.00 09/2017 Page 2of 5

ÌSWPIÇ~a;Î SWPI9465 ÌSWPIÇ~a;Î SWPI9465 ÌSWPIÇ~a;Î SWPI9465 ÌSWPIÇ~a;Î SWPI9465 Department of Health can beused. circumstances acatheter, like with anepidural, work (usually within 5–10minutes). In some working. This typeof anaesthesia is quick to you will beunable to move your legs while it is blocks themovement signals which mean that medication mixes with thespinal fluid.It also spinal space by a very fine needle where the of anaesthetic medicines, is given into the With a Patient Controlled Epidural Analgesia (PCEA). yourself adose of thepain relief. This is called or you may have abutton to push to give needed. You may have aconstant slow infusion given through this tube for anumberof days if is taped onto your back andmedicines can be the tubing is inplace. The fine plastic tubing the spinal cord). The needle is removed after your back (outside thespinal space that holds tube is inserted through anepidural needle into With an anaesthetic. help, including switching to adifferent kind of anaesthetist as there are things they can doto the right place. If you findthis difficult, tell your take more than oneattempt to get theneedle in discomfort, tingling orshock sensations. It can still as possible andto tell them if you feel any or epidural needle, they will ask you to stay as When theanaesthetist is inserting thespinal Image 2:Person lying ontheirside with knees bent. and bending over from thewaist. Image 1:Person sitting ontheside of apatient trolley, the pain of theepidural orspinal needle. Local anaesthetic is given into the skin to reduce procedure? 7. What happens during my anaesthetic spinal epidural anaesthetic asingle injection (continued) anaesthetic, a very thinplastic

Epidural and spinal anaesthesia patient information 8. What happens after theepidural or Image 3: The spinal andepidural spaces. around thearea of theoperation. you may feel movement and pressure sensations While you will bepain free during anoperation, area is numb. operation begin until they are satisfied that the take effect. The anaesthetist will not let the as theepidural orspinal anaesthetic starts to You may notice awarm tingling sensation procedure? 7. What happens during my anaesthetic • • In preparation for your procedure: anaesthetic if you dothefollowing: You are at less risk of problems from an having ananaesthetic block? nerve 9. What are my responsibilities before • • • spinal anaesthetic? weight safely. anaesthetic. Ask your GPabout losing will reduce many of therisks of having an If you are overweight, losing someweight Ask your GPabout exercising safely. improve your blood circulation andlung health. Increase your fitness before your procedure to GP/emergency department. severe back pain contact theanaesthetist/your have any numbness, weakness, headache or Within thefirst 2 weeks aftera spinal if you the pain becomes too obvious. operation site—ask for more pain relief before may become aware of somepain from the some tingling intheskin. At this point, you As sensation returns, you may experience attempt to walk by yourself. help from thenurse to help you walk. Donot time, you will beunsteady on your feet—ask for if you have anepidural infusion. During this to 4hours to wear off orcontinue for longer The numbness andweakness may take up (continued) v3.00 09/2017 Page 3 of 5

Department of Health • • • On theday of your procedure: • • • • • (continued) having ananaesthetic block? nerve 9. What are my responsibilities before – and turmeric: herbal/alternative medicines, such as fish oil rivaroxaban (Xarelto) orcomplementary/ apixaban (Eliquis), dabigatran (Pradaxa), ticagrelor (Brilinta), ticlopidine (Tilodene), (Effient), dipyridamole (Persantin or Asasantin), clopidogrel (Plavix, Iscover, Coplavix), prasugrel thinning) medicines such as warfarin, aspirin, If you take anticoagulant orantiplatelet (blood anaesthetic. before your surgery as these may affect the recreational smoking such as marijuana) Stop taking recreational drugs (this includes surgery. Do not drink any alcohol 24 hours before effect of theanaesthetic medicines. Drink less alcohol, as alcohol may alter the (13 78 48). during and afteranoperation. Phone13 QUIT your blood andincreases breathing problems to improve. Smoking cuts down theoxygen in surgery to give your lungs andheart achance Stop smoking as early as possible before your – there are someimportant exceptions: should becontinued before anoperation, but If you are taking medicines: smoke ordrink alcohol. If you are asmoker ordrink alcohol: your lungs. you vomit, there will benothing to go into to make sure your stomach is empty sothat if operation may bedelayed orcancelled. This is or chew gumafter this timeotherwise your drink. DoNOT eat (including lollies), drink, will betold whento have your last meal and Nothing to eat ordrink – – about yourmedicines your doctor will provide specific instructions thinning medicine. doctor when you can restart theblood medicine before your procedure, ask your if you are asked to stop taking blood thinning without medical advice do NOT stop blood thinning medicines affect your blood clotting should stop taking it before surgery as it may ask your surgeon and/oranaesthetist if you

(‘nil by mouth’): you most medicines donot Epidural and spinal anaesthesia patient information

• • (continued) having ananaesthetic block? nerve 9. What are my responsibilities before • • • websites: following informationFurther may befound onthe before-after/index.html www.qld.gov.au/health/services/hospital-care/ on theQueensland Health website: and after Information on 10. Useful sources of information – – – – – you have: Tell your doctor andtheanaesthetist if for advice. If you feel unwell: – the RCoA has not reviewed these as a whole) after a spinal or epidural injection, 2015’ ‘Your spinal anaesthetic, 2014’ Royal College of Anaesthetists’ (RCoA) leaflets (This publication includes text taken from the www.rcoa.ac.uk/patientinfo Royal College of Anaesthetists: of Anaesthetists: Australian andNew Zealand College www.health.qld.gov.au/consent Queensland Health: – supplements; this may include andare not counter medicines, herbal remedies and been taking prescribed and/orover the dental problems false teeth, caps, loose teeth orother problems with anaesthesia had previous problems and/orknown family a drugaddiction a stay inhospital is needed illnesses), including if regular treatment or pressure, infectious diseases, serious health problems (e.g. diabetes, highblood you are taking. supplements to show your anaesthetist what the counter, herbal remedies and medicines, those medicines you buy over take to thehospital all your prescribed side effects. allergies/intolerances of any typeand diabetic medicines (e.g. insulin) contraceptive pill, antidepressants and/or limited to blood thinning medicines, the and Surgical procedures Hospital care: before, during www.anzca.edu.au/patients telephone theward/hospital

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. ÌSWPIÇ~a;Î SWPI9465 ÌSWPIÇ~a;Î SWPI9465 ÌSWPIÇ~a;Î SWPI9465 ÌSWPIÇ~a;Î SWPI9465 Department of Health proposed procedure. about your condition, treatment options and or any otherinformation you have beengiven information inthis patient information sheet you donot understand any aspect of the Ask your doctor/healthcare professional if doctor/healthcare professional 11. Questions to ask my

Epidural and spinal anaesthesia patient information doctor/healthcare professional 11. Questions to ask my Your local contact details are: 12. Contact us v3.00 09/2017 Page 5 of 5

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