General and Spinal Anaesthesia
The following gives you a general overview of options for anaesthesia for surgery. Discuss your options directly with Dr Onuma or your anaesthetist.
What choices of anaesthesia do I have?
Your options for anaesthesia will depend to some extent on the type of surgery you are having. Broadly speaking you can have a general anaesthetic, a regional anaesthetic, or local anaesthetic with sedation. If your surgery involves laparoscopic surgery or open abdominal surgery then you will require a general anaesthetic.
What are the differences?
General anaesthesia means you are completely unconscious and unaware during your operation. Regional anaesthesia means one part of your body is made numb so that you don’t feel the surgery. This usually means you have an epidural or spinal anaesthetic. You can also have some sedation so that you sleep lightly during your operation. Local anaesthetic can also be used to numb just one tiny part of skin, but this choice is not suitable for most major operations.
What is spinal anaesthesia?
Spinal anaesthesia is a common way of providing good, safe anaesthesia for many operations, and is especially suited to vaginal surgery. Spinals are similar to epidurals, but have some significant advantages. Spinals are usually easier to insert, work much more quickly and are more reliable than epidurals. Having a spinal involves an injection in your lower back, into the spinal fluid, of a small amount of local anaesthetic. A few minutes afterwards, you become numb from the waist down. Your legs will also get very heavy. You can then have your surgery in complete comfort.
What are the advantages of a spinal over a general anaesthetic?
There are numerous small factors, which add up to make spinal anaesthesia a good choice. General anaesthesia will make you feel tired and sleepy for several hours afterwards. Nausea and vomiting is common after general anaesthesia, but much less of a problem with a spinal. Control of your pain is usually easier after a spinal, and we have noticed that women who have a spinal tend to get up and out of bed sooner, and are more comfortable. There is probably a reduction in the amount of blood lost during surgery, and the risk of a deep vein thrombosis, a potentially serious complication of any surgery, is less after spinal anaesthesia. If you have any other serious health problems, such as heart disease, asthma, emphysema, diabetes or blood pressure, then the benefits of spinal anaesthesia are even greater.
Do I have to be awake during the operation?
No, you don’t. You will be offered some sedation to let you sleep lightly during the operation. The amount of sedation you have can easily be adjusted to your needs, so that you can be almost completely unaware of the surgery, or just calm and drowsy, its up to you.
But aren’t there some serious risks from spinals?
Yes there are, but serious problems after spinals are very rare, and don’t forget that serious problems occur with general anaesthesia too.
Common side effects from spinals are the chance of a slight backache afterwards, which is usually only a minor short-term problem. Your blood pressure commonly falls a bit during the operation, but your Anaesthetist will monitor and correct this as necessary. There is a small chance of developing a bad headache afterwards, called a spinal headache. This is usually self-limiting and easy to treat, but very occasionally persists for several days.
Serious complications include the risk of infection or bleeding around the spine, and the possibility of damage to nerves causing permanent disability. It is true that these things do happen, but they are extremely rare, and probably rarer than the serious complications of general anaesthesia.
Can everyone have a spinal?
No, there are some reasons why it not safe for some people to have a spinal. If you are taking medications to thin the blood, like warfarin, then unless these medications are stopped well before surgery (which is not always advisable) the risk of bleeding into the spine is too great. There are also some back problems that make spinals difficult or impossible. However just because you have a back problem does not mean that you can’t have a spinal.
How can I find out more before my operation?
If you are still unsure about what type of anaesthetic to have, your Gynaecologist can arrange for you to see your Anaesthetist well before surgery to help you decide. Just ask how to make an appointment to see your Anaesthetist.
Prepared by Dr Paul McAleer (and edited by Dr Onuma)
Specialist Anaesthetic Services
Adelaide, South Australia
(08) 8410 5666