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Spinal Anaesthesia
Spinal Anaesthesia is a highly effective regional anaesthetic technique that produces complete numbness and motor block of the lower body by injecting local anaesthetic into the spinal fluid - allowing major lower limb, pelvic, and abdominal surgery with the patient comfortable and awake.
Overview
Spinal Anaesthesia is performed by injecting a small volume of local anaesthetic - with or without an opioid adjuvant - into the cerebrospinal fluid of the lumbar spinal canal using a very fine pencil-point needle. Within 5 to 10 minutes, complete sensory and motor block develops from the waist downward, providing profound anaesthesia without the need for general anaesthesia. The patient remains conscious, comfortable, and able to communicate throughout, while the anaesthesiologist monitors vital signs continuously. Spinal anaesthesia is the preferred technique for caesarean section, hip and knee replacement, prostate surgery, and many lower abdominal procedures.
Types of Spinal Anaesthesia
The specific agent, dose, and adjuvants are selected based on the procedure duration and the required block level.
- Isobaric Spinal (level unaffected by position - predictable spread)
- Hyperbaric Spinal (heavier than CSF - position can direct block level)
- Combined Spinal-Epidural (CSE - immediate spinal with epidural for top-up or post-operative analgesia)
- Saddle Block (very low dose for perineal procedures)
- Continuous Spinal Anaesthesia (catheter for prolonged procedures - used selectively)
Risk Factors Relevant to Spinal Anaesthesia
Understanding contraindications and risk factors allows the anaesthesiologist to confirm spinal anaesthesia is the safest approach for each patient.
- Coagulopathy or anticoagulant therapy - increases risk of epidural haematoma
- Active skin infection at the injection site - absolute contraindication
- Severe hypovolaemia - spinal vasodilation can cause profound hypotension
- Severe aortic stenosis - fixed cardiac output cannot compensate for spinal vasodilation
- Patient refusal or uncooperative patient - unsuitable for awake technique
- Previous spinal surgery - altered anatomy may make needle placement difficult
Indications for Spinal Anaesthesia
Spinal anaesthesia is preferred over general anaesthesia for many lower body procedures due to its superior safety profile and analgesic benefits.
- Caesarean section - gold standard anaesthetic for elective and emergency LSCS
- Hip and knee replacement surgery
- Transurethral prostate resection (TURP)
- Lower limb orthopaedic surgery
- Inguinal and femoral hernia repair
- Haemorrhoidectomy and anal procedures
- Lower abdominal gynaecological surgery
- Endovascular procedures requiring lower limb immobility
Key Benefits
Discover the advantages of choosing our spinal anaesthesia services.
Avoids the risks of general anaesthesia particularly for high cardiovascular risk patients
Excellent surgical anaesthesia with superior post-operative analgesia lasting 2 to 4 hours
Patient remains conscious and able to communicate reassuringly throughout
Rapid recovery with no post-anaesthetic drowsiness nausea or confusion
Safe and highly effective for lower limb pelvic and lower abdominal procedures
Clinical Features
The technology, techniques and clinical approach behind our spinal anaesthesia.
Pencil-point spinal needle minimises post-dural puncture headache risk
CSF confirmation confirms correct position before any drug is injected
Block level testing confirms adequate anaesthesia before surgery starts
Continuous blood pressure monitoring with vasopressor immediately available
Awake patient allows immediate communication throughout the procedure
Preparation Instructions
The spinal block typically wears off within 2 to 4 hours depending on the agent used. Do not attempt to stand or walk until full movement and sensation has returned to both legs - the nursing team will assess this before allowing mobilisation. Mild post-operative headache from spinal anaesthesia occurs in less than 1% of cases with modern fine needles - inform the team immediately if you develop a positional headache that is worse sitting up. Contact your anaesthesiologist for any persistent weakness, numbness, or back pain after the block resolves.
The Procedure
Step-by-step guide to what you can expect during your spinal anaesthesia procedure.
Positioning and Skin Preparation
You are positioned sitting forward or lying on your side with knees drawn up. The lower back is cleaned with antiseptic and local anaesthetic numbs the skin before the spinal needle is advanced.
Spinal Needle Insertion and CSF Confirmation
A fine pencil-point needle is advanced into the subarachnoid space. Free flow of clear CSF confirms correct needle placement before any medication is injected.
Local Anaesthetic Injection
A calculated volume of local anaesthetic is injected into the spinal fluid. You may feel warm tingling spreading down your legs as the block develops over 5 to 10 minutes.
Block Level Assessment
The anaesthesiologist confirms adequate anaesthesia of the surgical area using cold or pinprick testing before surgery begins -- ensuring complete numbness of the operative field.
Monitoring Throughout Surgery
Blood pressure, heart rate, and oxygen saturation are monitored continuously. A screen ensures you cannot see the surgical field. You remain awake and able to communicate throughout.
Block Regression and Safe Mobilisation
The block gradually wears off in 2 to 4 hours. Do not attempt to stand until full sensation and movement has returned to both legs -- the nursing team confirms this before allowing mobilisation.
What to Expect
You will be positioned either sitting forward or lying on your side with knees drawn up. After skin cleaning and local anaesthetic injection at the needle site, a very fine spinal needle is advanced into the spinal fluid - most patients feel only mild pressure. The local anaesthetic is injected and within minutes your legs become warm, heavy, and numb. You remain awake and comfortable throughout surgery while the anaesthesiologist monitors your blood pressure and heart rate continuously.
Frequently Asked Questions
Common questions about spinal anaesthesia.
Related Services
Explore other services in our Anaesthesiology department.
General Anaesthesia
Epidural Anaesthesia
Regional Nerve Block
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