Your spinal anaesthetic

A local anaesthetic drug is injected through a needle into the small of your back. This numbs the nerves from the waist down to the toes for two to three hours.

For many operations, patients will have a general anaesthetic. They will stay anaesthetised during the operation.

A “spinal” may be safer for you and suit you better. It is used for most operations below the waist line. It has benefits for both you and your surgeon.

You can normally choose:

• to stay fully conscious
• to have some mild sedation as well. This makes you relaxed and sleepy although you stay conscious, or you may be given a spinal along with a general anaesthetic

Why have a spinal?

Advantages can include:

• Less blood loss during surgery, with less need for a blood transfusion
• Less risk of blood clots forming in the leg veins (deep vein thrombosis)
• Less risk of chest infections after surgery
• Less effect on the heart and lungs
• Excellent pain relief straight after surgery
• Less need for strong pain relief drugs
• Less sickness and vomiting
• You may be able to start to drink and eat sooner
• Older people are not so confused after the operation

How is it given?

A needle will be used to put a thin plastic tube (‘cannula’) into a vein in your hand or arm. The staff looking after you will then help you to get into the correct position.

You will sit on the side of the bed with your feet on a low stool. Or, you will lie on your side, curled up with
your knees up towards your chest. In either case, the staff will support you during the injection.

Your anaesthetist will give you the spinal and stay with you

He or she will explain what is happening so that you know what is going on behind your back

What will I feel?

As the injection is given you may feel pins and needles or a sharp tingle in one of your legs. If you do, try to keep still, and tell your anaesthetist about it. (See side effects and complications.)

To start with the skin feels numb to touch and the leg muscles are weak. When it is working fully you will not be able to move your legs or feel any pain below your waist.

During the operation you may be given oxygen to breathe through a light weight, clear plastic mask. This will improve oxygen levels in your blood.

It takes 1½ to 4 hours for feeling to return to the part of your body that is numb. You should tell the ward staff if you have any concerns or worries.

Your nurses will make sure that this area is protected until feeling comes back. As feeling does comes back, your skin may feel tingly.

At this point you may feel pain. If so, ask for more pain relief before the pain gets too bad.

Please ask for help when you first get out of bed.

You should be able to drink fluids within an hour of the operation. You may also be able to eat a light meal.

A spinal may be used for:

• Orthopaedic surgery – any major operation on the leg bones or joints.
• General surgery – hernia repair, varicose veins, piles (haemorrhoids).
• Vascular surgery – repairs to the blood vessels in the leg.
• Gynaecology – vaginal repair or operations on the bladder outlet.
• Urology – prostate removal, bladder operations and genital surgery.
• However you may still need a general anaesthetic if:
  - the spinal cannot be given in a satisfactory way
  - the spinal does not work well enough
  - the surgery is more complicated than expected

As with all anaesthetics there may be side effects or complications.

Very common and common side effects:

These may not be pleasant, but are easily treated and do not last long.

• Headache - when you begin to move around there is a risk of getting a headache.
• Low blood pressure. As the spinal takes effect, it can lower your blood pressure and make you feel faint or sick. This can be controlled with the fluids given by drip. And by giving you drugs to raise your blood pressure.
• Itching - can be a side effect of using morphine-like drugs along with local anaesthetic drugs. This can be treated, as long as you tell the staff when it happens.
• Difficulty passing water. It may be difficult to pass water normally. This will return to normal after the spinal wears off.
• You may need to have a catheter put in your bladder for a while. This may be while the spinal wears off or as part of the operation.
• Pain during the injection. Tell your anaesthetist straight away if you feel pain or pins and needles in your legs or bottom. This may be a sign of irritation or damage to a nerve. The needle will need to be moved.

Rare complications

Nerve damage. You may have loss of feeling, pins and needles and muscle weakness. This may last for a few days or even weeks. Permanent nerve damage is even more rare.

Frequently asked questions

Can I eat and drink before my spinal?

• You will need to have an empty stomach (fast) before your operation. This is because it may be necessary to change from a spinal to a general anaesthetic. The hospital should give you clear instructions about this.

Will I see what is happening to me?

• Sometimes you can choose. Normally a screen is put across your upper chest so that you see nothing when surgery starts.
• Some operations use video cameras and telescopes for “keyhole” surgery.
• Many patients like to see what is happening to them on the video screen.

Can I refuse to have the spinal?

• Yes, you will never be forced to have anything that you do not want.

Where can I learn more about spinals?

• If you would like more detailed information, speak to your anaesthetist. Or, contact the organisations at the end of the leaflet.

• Who will give me my anaesthetic?
• Do I have to have this type of anaesthetic?
• Have you often used this type of anaesthetic?
• What are the risks?
• Do I have any special risks?
• How will I feel after the operation?

Association of Anaesthetists of Great Britain and Ireland

21 Portland Place
London WC1B 1PY
Phone: +44 20 7631 1650
Fax: +44 20 7631 4352
E-mail: info@aagb.org
Website: www.aagbi.org 

This organisation works to promote the development of anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland.

Royal College of Anaesthetists
48-49 Russell Square
London WC1B 4JY.
Phone: + 44 20 7813 1900
Fax: + 44 20 7813 1876
E-mail:info@rcoa.ac.uk
Website: www.rcoa.ac.uk 

This organisation is responsible for standards in anaesthesia, critical care and pain management throughout the UK.

Adapted from a leaflet from The Royal College of Anaesthetists and The Association of Anaesthetists
of Great Britain and Ireland. (Second Edition January 2003)