Spinal Anesthesia for C-section – Advantages and Disadvantages

A lot is going on in the mind of a mother-to-be when she is about to have a C-section. It is a major surgery, and it is only natural for a woman to have concerns about anaesthesia—the type of anaesthesia the doctor will use, how it will pan out, and more. You may have heard about an epidural, but spinal anaesthesia for C-sections is a more commonly used method. It allows the mother to remain awake and alert during the procedure while minimising pain. However, like any medical intervention, it comes with its own set of advantages and disadvantages. If you want to learn about spinal anaesthesia, read on!

What Is a Spinal Block?

A spinal block is a type of regional anaesthetic injected directly into the cerebrospinal fluid that bathes the nerves and spinal cord. It is different from a spinal epidural. The spinal block is injected directly into the spinal fluid, which quickly and effectively blocks the pain for a few hours. The patient feels numb from the abdomen down, but they can use their arms, head, and upper body.

In contrast, an epidural uses a larger needle that goes into the epidural space, not the membrane that covers the spinal cord. A catheter is then used to administer the anaesthetic for a long time continually, and it can be made to last longer than a spinal. A spinal block is given if you decide that you need pain relief late in labour or when there is not enough time for an epidural, and the delivery is likely to be very soon. It is also the preferred spinal injection for a C-section if you do not already have an epidural in place (1).

How Is Spinal Anaesthesia Administered?

The painkilling drugs are injected into the spinal fluid surrounding the nerves and the spinal cord. To do that, the anaesthesiologist uses a very fine needle to penetrate the dura, the tissue which encapsulates the spinal cord and the spinal fluid. The spinal is a single injection of an anaesthetic in the spinal area and is a one-shot deal; therefore, there is only one chance to deliver the drugs. It’s also noteworthy that there is almost no chance of mistakenly piercing your spinal cord as the needle goes inside below where the spinal cord ends.

The way this is performed is quite simple. Your anaesthesiologist will ask you to sit on the side of the bed or lie on your side. Your back will be cleaned with an iodine solution, and a sticky, plastic guard-contact paper will be placed on your back. A topical anaesthetic will be used first; then, the drugs will be injected into the spinal fluid with a fine needle. It will leave you numb but ambulatory. However, you won’t be able to walk for a while (2).

How Does a Spinal Block Work?

The effects of a spinal block are quick as it helps relieve pain in the lower body, down from the abdomen, for a limited period. During this time, a woman is alert and knows everything happening. If given a spinal block, you can move your arms, head, and upper body but won’t feel sensation in your lower body. The anaesthetic is injected using a fine needle, which is carefully guided into the membrane surrounding the spinal cord through your lower back. Since they spread more easily in the spinal fluid, only a small dose of anaesthetic is required in this case, and it works by blocking the pain signals going from the uterus and lower body to the brain. This will also stop you from feeling contractions, and your abdomen will numb in about 10 minutes.

Who Should Avoid Taking a Spinal?

Not all women are given spinal for pain relief. It is avoided if they have abnormally low blood pressure because of problems such as bleeding, blood infections, previous allergic reactions to local anaesthetics, or a skin infection in the lower back where the needle enters. It is also not given to women who are on some specific blood-thinning medications.

What Are the Benefits of Having Spinal Anaesthesia for a C-section?

Spinal anaesthesia offers several benefits for a C-section, making it a preferred choice for many mothers. Here are a few key advantages:

• Spinal anaesthesia prevents the need for a general anaesthetic during the procedure. This means you will be fully awake and can participate in the birth of your baby along with your partner in the operating theatre.
• You will have almost complete pain relief and be alert during the procedure. Unlike under a general anaesthetic, you are also less likely to feel sick.
• Once your baby is born, you can hold him right away and start feeding him. The baby will also be more alert if you are not under a general anaesthetic.
• Unlike an epidural, where a tube is left stuck to the back, the spinal is given as a single injection for pain relief.
• It is much faster than an epidural and gives rapid pain relief that kicks in within five to ten minutes.
• The catheter inserted into your bladder is likely to be for a shorter period compared to an epidural.

Side Effects of Spinal Anaesthesia for C-Section

While spinal anaesthesia is generally safe and effective for C-sections, it can come with some side effects that mothers should be aware of. Below are common side effects associated with spinal anaesthesia during C-section (3):

1. Muscle Weakness

Depending on the drugs administered, you may or may not be able to maintain sufficient muscle strength, which means you may not be able to move around, even with assistance. Either way, obstetric caregivers will recommend you stay in bed after you’ve had a spinal block.

2. Itchiness and Nausea

If opioids are used, especially ones such as fentanyl, it can cause itchiness around the nose and lips. Some women also get nauseous and throw up during labour.

3. Respiratory and Circulatory Depression

In some cases, it can cause mild respiratory and circulatory depression. When the drugs used in the anaesthesia travel higher than intended within the spinal fluid, a high spinal block or high neural blockade can occur. This is more common in women who are short, obese or sensitive in general to anaesthesia. Anaesthesia can cause mild shortness of breath and numbness or weakness in the upper body, such as in the shoulders, arms, and trunk. This is followed by nausea with or without vomiting. At first, the high spinal block can seem frightening, but it’s not life-threatening. It can be treated with intravenous drugs, stabilising the heart rate and blood pressure, and supplemental oxygen.

4. Post-Dural Puncture Headache

To administer anaesthesia, your spinal cord’s protective membrane is purposefully punctured. This can cause some of the spinal fluid to leak, giving rise to headaches. While they are not severe, they can be troublesome. Women often describe throbbing and episodic pain around the forehead, behind the eyes or at the base of the head extending down to the spine. Most resolve within a few hours, and only about 1 in 500 women report severe headaches (6).

5. Back Pain

Backaches are also reported as a result of trauma caused by needles piercing layers of fat, muscle, and ligaments. The pain is usually dull and has mild soreness, which resolves within a few weeks.

FAQs

1. Spinal block for C-section – Does it hurt?

The procedure of getting a spinal block is generally quick and painless, but you may feel a stinging sensation when the drugs are first injected into the site. If you feel pins or needles in your legs during the injection, immediately tell your anaesthetist about it. It may be a sign of temporary nerve damage, and the needle needs to be re-positioned. Temporary nerve damage is rare and repairs itself in a few months. Only about one in 1000 to 2000 women are affected by this.

2. General anaesthesia vs. spinal anaesthesia for C-section?

General anaesthesia leads to a total loss of sensation and consciousness. This means you are not awake and won’t have reflexes. It is given under emergencies or when the regional anaesthetic doesn’t work (5).

3. Spinal or Epidural for a C-section – Which one should you consider?

Both of these are regional anaesthetics. The difference between spinal and epidural c-sections lies in the duration of numbing and their effectiveness. While spinal blocks are given in one shot and have a high quality of pain-blocking for a shorter period, epidurals last longer and are not as potent at blocking the pain. A spinal block is often used as a c-section and is generally not a long procedure; therefore, a continuous drip of anaesthesia, i.e. an epidural, is unnecessary (4).

4. Can spinal anaesthesia affect the baby?

Spinal anaesthesia is generally safe for the baby. It does not significantly affect the baby’s health or development. The anaesthetic is localised and doesn’t cross the placenta in significant amounts (7).

In general, there is not much to worry about spinal anaesthesia. However, if you are concerned, speak to your gynaecologist. She will guide you the best.

References/Resources:

1. Olawin. A. M, Das. J. M; Spinal Anesthesia; National Library of Medicine; https://www.ncbi.nlm.nih.gov/books/NBK537299/

2. Spinal anaesthetic; NHS; https://www.nhsfife.org/services/patients-carers-and-visitors/preparing-for-surgery/general-information-about-your-anaesthetic/spinal-anaesthetic/

3. Spinal anaesthetic; Healthdirect; https://www.healthdirect.gov.au/surgery/spinal-anaesthetic#complications

4. Spinal Block Vs Epidural: What’s The Difference?; Harley Street Specialist Hospital; https://hssh.health/blog/spinal-block-vs-epidural-whats-the-difference/

5. Pain Management for C-Sections; Yale Medicine; https://www.yalemedicine.org/conditions/anesthesia-for-c-section

6. The Centennial of Spinal Anesthesia; American Society of Anesthesiologists;
https://pubs.asahq.org/anesthesiology/article/89/2/500/36948/The-Centennial-of-Spinal-Anesthesia

7. Spinal Anaesthetic; NHS; https://www.newcastle-hospitals.nhs.uk/services/maternity/labour-and-birth/pain-relief/spinal-anaesthetic/#

Also Read:

Anaesthesia for C-Section Delivery
Epidural Anaesthesia during Labour
Epidural Side Effects on the Mother and Baby