Epidural and spinal anaesthesia Informed consent: patient information This information sheet answers frequently asked questions about having epidural and spinal anaesthesia. It has been developed to be used in discussion with your doctor or healthcare professional. 1. What is a spinal or epidural 2. Potential benefits of an epidural or anaesthetic and how will it help me? spinal anaesthetic (continued) For some operations on the lower half of the • improved bowel recovery after bowel surgery body, local anaesthetic medicine is injected • improved blood flow after vascular surgery © The State of Queensland (Queensland Health) 2017 Health) (Queensland Queensland of State The © Source of images 1 & 2: Royal College of Anaesthetists of College 1 & 2: Royal images of Source To request permission email: [email protected] email: permission request To through a needle and/or thin plastic tubing into • if you are having a caesarean section birth, you the middle of your lower back. This can numb will be able to see your baby as soon as they the nerves supplying the lower part/half of are born, the baby will only get incredibly small your body for one to four hours and sometimes amounts of any medications given and your Except as permitted under the Copyright Act 1968, no part of this work may be may work this no part of 1968, Act the Copyright under permitted as Except longer. During this time it will be difficult or partner can be with you. reproduced communicated or adapted without permission from Queensland Health Queensland from permission without or adapted communicated reproduced impossible to move your legs as normal. Other 3. What are the risks of the anaesthetic? medicine may be injected at the same time that prolongs pain relief for many hours. The Every anaesthetic has a risk of side effects medicine works by blocking the pain signals and complications. Whilst these are usually from reaching your brain. temporary, some of them may cause long-term problems. Depending on your medical condition and the Common side effects and complications operation you are having, an epidural and/ include: or spinal anaesthetic may be safer or more • low blood pressure: comfortable for you than having a general – this can make you feel faint or sick anaesthetic. – the anaesthetist can treat low blood pressure Epidural and spinal anaesthetics are similar but with fluids and medications given through different types of anaesthetic and sometimes your drip into your vein both are given together. Epidural and spinal • nausea and vomiting anaesthetics are also a type of ‘regional • shivering anaesthetic’ or ‘regional nerve block’. • itching: During your epidural and/or spinal anaesthetic – is a side effect of some of the medications in you may be fully awake, sedated or also be the anaesthetic given a general anaesthetic. Your anaesthetist – inform the staff if you are itchy—it can be will discuss this with you before the operation. treated • problems in passing urine (urinary retention): 2. Potential benefits of an epidural or – you may require a catheter to be placed in spinal anaesthetic your bladder while the anaesthetic wears off The advantages of an epidural and/or spinal and for a short time afterwards anaesthetic compared to a general anaesthetic – bowel function is not affected include: • pain during the injection: • less risk of a chest infection after surgery – immediately tell your anaesthetist if you feel • less effect on the lungs and breathing pain in places other than where the needle is • excellent pain relief immediately after surgery – the pain might be in your legs or bottom and • less need for strong pain-relieving medicines, might be due to the needle touching a nerve and their side effects, including nausea, – the needle may need to be repositioned confusion, drowsiness, and constipation • headache: • less sickness and vomiting – there are many causes of headache after an • quicker return to drinking and eating after operation, including the anaesthetic, being surgery dehydrated, not eating and anxiety SWPI9465 SWPI9465 • less risk of becoming confused after the – most headaches get better within a few operation, especially if you are an older person hours and can be treated with pain relieving medicines ÌSWPIÇ~a;Î ÌSWPIÇ~a;Î Department of Health Epidural and spinal anaesthesia patient information v3.00 09/2017 Page 1 of 5 3. What are the risks of having an 3. What are the risks of having an anaesthetic? (continued) anaesthetic? (continued) • bruising (haematoma) at the injection site: • seizures (convulsions or fits) – if you take blood thinning medicines you are • meningitis more likely to get a haematoma as it may • cardiac arrest affect your blood clotting • severe harm or death (very rare). • pain and tenderness at the injection site 4. What are my specific risks? (usually temporary) • aches and pains There may also be risks specific to your • prolonged numbness or tingling individual condition and circumstances. Your • chest infection. doctor/healthcare professional will discuss these with you. Ensure they are written on the Uncommon side effects and complications consent form before you sign it. include: • severe headache: 5. What are the risks of not having the – can occur after a spinal injection proposed anaesthetic? – it will get worse on sitting or standing and There may be consequences if you choose not to improves if you lie down have the proposed anaesthetic. Please discuss – you will need to see an anaesthetist these with your doctor/healthcare professional. – if you are still in hospital, your nurses and/or the surgical team will contact your 6. What does my anaesthetist do? anaesthetist for an assessment Your anaesthetist is a doctor with specialist – if you have left hospital, seek help from your training who will: GP or by attending the emergency department • assess your health and then discuss with • temporary nerve damage: you the type of anaesthetic suitable for your – temporary loss of sensation, pins and surgery or procedure needles and sometimes muscle weakness in • discuss the risks of suitable anaesthetic the lower body options – may last for a few days, weeks or months • agree to a plan with you for your anaesthetic • overdose of medicines which may lead to slow and pain control breathing: the anaesthetist can treat this • be responsible for giving your anaesthetic and • the anaesthetic does not fully work: this may caring for you during your surgery and straight require further anaesthetic and/or a different after your surgery or procedure method of anaesthesia to be used • manage blood transfusions if required. • allergic reaction • existing medical problems getting worse. You may be seen and cared for by a specialist Rare side effects and complications include: anaesthetist, a GP with training in anaesthetics • permanent nerve damage with possible (particularly in rural areas) or a doctor/ paralysis: it has about the same chance of healthcare professional/student undergoing occurring as major complications of having a further training. All trainees are supervised general anaesthetic according to relevant professional guidelines. • severe breathing difficulty: the block may go 7. What happens during my anaesthetic higher than planned and affect breathing by procedure? paralysing the breathing muscles • infection (e.g. around injection site and Before the procedure commences, a ‘drip’ (also epidural catheter; epidural abscess) requiring known as a cannula, intravenous fluids or IV) is antibiotics and further treatment always put into one of your veins, usually in your • short term deafness hand or lower arm. • double vision You will normally have the epidural or spinal • blood clot with spinal cord damage injection into your back either sitting, or lying • serious allergic reaction on your side, on the trolley or operating table. • equipment failure (e.g. breakage of needles or The anaesthetist and the team will explain what catheters possibly requiring surgery to remove they want you to do. Just like an operation, the SWPI9465 SWPI9465 them) injections are done in a very clean (sterile) way. • leaking of stomach content into the lungs Department of Health Epidural and spinal anaesthesia patient information v3.00 09/2017 Page 2 of 5 ÌSWPIÇ~a;Î ÌSWPIÇ~a;Î 7. What happens during my anaesthetic 7. What happens during my anaesthetic procedure? (continued) procedure? (continued) Local anaesthetic is given into the skin to reduce You may notice a warm tingling sensation the pain of the epidural or spinal needle. as the epidural or spinal anaesthetic starts to take effect. The anaesthetist will not let the operation begin until they are satisfied that the area is numb. While you will be pain free during an operation, you may feel movement and pressure sensations around the area of the operation. Image 1: Person sitting on the side of a patient trolley, and bending over from the waist. Image 3: The spinal and epidural spaces. Image 2: Person lying on their side with knees bent. When the anaesthetist is inserting the spinal 8. What happens after the epidural or or epidural needle, they will ask you to stay as spinal anaesthetic? still as possible and to tell them if you feel any • The numbness and weakness may take up discomfort, tingling or shock sensations. It can to 4 hours to wear off or continue for longer take more than one attempt to get the needle in if you have an epidural infusion. During this the right place. If you find this difficult, tell your time, you will be unsteady on your feet—ask for anaesthetist as there are things they can do to help from the nurse to help you walk. Do not help, including switching to a different kind of attempt to walk by yourself. anaesthetic. • As sensation returns, you may experience With an epidural anaesthetic, a very thin plastic some tingling in the skin.