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Spinal analgesia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Spinal analgesia is the suppression of pain and other sensation in a part of the body by injection of a analgesic drug or local anaesthetic into the space around the spinal cord. Two forms are commonly employed: epidural and subarachnoid routes. There is some confusion in the terminology - spinal analgesia is commonly taken to mean the subarachnoid route, and extradural is another term for epidural.

This technique is commonly used post-operatively and in complications of the third stage of labour.

Advantages:

  • effective, with rapid onset
  • minimal drug dose needed
  • hypotension due to sympathetic blockade reduces the risk of haemorrhage
  • muscular relaxation often permits surgery without disrupting spontaneous ventilation

Disadvantages:

  • "one-shot" technique unless catheter infusion
  • risk profound hypotension
  • post-spinal headache in 15% of cases; does not occur with epidural analgesia
  • very rarely, risk of meningeal infection

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