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Combination Spinal-Epidural Anesthesia

Spinals and Epidurals are used very often at the Hospital for Special Surgery for any surgery below the waist. All of these blocks are performed once you have received some sedation through your intravenous line. Patients often have no recollection of undergoing a spinal or epidural. Once sedated, your anesthesiologist will either sit you upright or place you on your side for the anesthetic.

He or she will clean your back with an iodine containing solution. A plastic drape is used to maintain sterility. A small amount of local anesthetic is then injected into the skin to reduce discomfort during the procedure. Your anesthesiologist will insert a needle through the ligaments of your back into the epidural space. Once in the space, he/she will place a smaller needle through the epidural needle into the fluid which normally surrounds the spinal cord. Once in place, a small amount of lidocaine-like medicine is injected. Then, a small plastic tube (catheter) is inserted into the epidural space and all needles are removed.

You will notice at the end of your surgery that you will have some tape along your back, tracing the line of the epidural catheter. However, because there is nothing hard or sharp in your back, you can lie flat on your back without discomfort. The epidural catheter will often stay in place for about 36 hours.

For shorter procedures, a stand-alone spinal is performed. In this procedure, your anesthesiologist will use the same small needle to enter the fluid surrounding the spinal cord but will not leave a catheter in the epidural space.

As with any anesthetic, there are risks and benefits to spinals and epidurals. These particulars can be discussed with your anesthesiologist before your surgery.

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