Spinal/ Epidural anaesthesia

So in terms of neuroaxial anesthesia we've got two techniques to offer. We've got the simple one is a spinal anesthesia so it's a simple injection we do in your lower back and that's going to make your your lower body from from your tummy to your toes numb. So how we do it, we first of all need to consult you and to explain you the risk and the benefit of this procedure. So the benefit is to sometimes avoid a general anaesthetic and so to be awake for the procedure. And it also provides some very good pain relief and some of the medication we give inside the spinal can last up to 18, 20 hours. So you will have some long-term pain relief after the procedure. As a risk, it might not work or might not work very well, we are in an elective situation and we'll make sure it works before we start. Do we know the spinal is working? Your legs are going to be very numb and it will be impossible for you to raise your legs in the air. You might be able to wiggle your toes but you won't be able to do anything else. So that's one first sign that our spinal is working very well. The second way of knowing the spinal is working well is to test it with some cold spray. You will not be able to feel your cold spray on your legs, on your tummy, and you will be able to feel it on your upper chest. So we know how numb you are and until which level you are numb. So that's how we know the spinal is working very well, and the surgeon will not go ahead without having those two signs. The third complication of spinal anesthesia is for your blood pressure to drop. That's why we need to have a drip in your hand first of all and to take your blood pressure very thoroughly from the beginning. You might feel drowsy. This is usually the first time that the blood pressure is dropping. And I'll be able to give you some medication for that. The third common complication of having a spinal is the risk of having a headache. It's about 1 in 200 cases. And usually the headache doesn't appear on day one or immediately, but appear on day one or day two. And the particularity of this headache is it gets worse when you sit up and it gets better when you lie down. If the headache is really bad, we can sometimes do another injection in your back to stop the headache. Then there's some very rare complications you can have with spinal, the risk of infections is very rare and that's why spinal is done in a theatre environment and in a very clean and sterile environment. So I will be wearing clothes like a surgeon, mask, glove, hat, gown to do that in a very a clean manner and we'll be spraying your back with some alcoholic solution to clean your back. And lastly, and extremely really, the risk of nerve damage, this is very, very rare. It's about one in 50,000 cases. And in medicine, it's all about balancing benefits and risks. And if we think the benefits of the spinal, you're going to get from the spinal in terms of pain relief, avoiding a joint anaesthetic, definitely outweigh the risk we are taking. In terms of how do we do it, you will be first of all putting a drip in your hand, putting some monitoring to check your heart rate, your blood pressure, your oxygen level, and you'll be sitting on the trolley and we'll be numbing the area. We're going to do the injection in your lower back with some local anaesthetic and then we'll do the injection. You might feel the first little injection of local anaesthetic, but then after you feel bit of pressure in your back, but it's not painful, it's not uncomfortable, and it's a very quick procedure. In less than two, three minutes, we can perform a spinal anesthesia. You're going to feel your bottom getting warm, numb, pins and needles in your legs, and see the first sign that the spinal is working well. We'll be lying down on the trolley, and we'll be waiting a couple of minutes to test the spinal before we allow you to go inside the operating theatre and then we'll be testing to make sure the spinal is working well before the surgeon is able to start the surgery. So there's no risk of long-term back pain with a spinal or epidural and that's been very well demonstrated in the literature. It doesn't affect your back on a long-term basis at all, and it is very safe. The epidural, it will be done in the same manner, and the risks are the same. What differentiates spinal from epidural will be doing, putting a little catheter in the space around your spine, and this little catheter, we can keep it up to 3 to 5 days and that will give you some very long term pain relief for 3 or more days. We leave it a maximum of 5 days because usually after the pain is well controlled with some of the amine and after 5 days is a risk of infection if we keep this epidural catheter in.