1、 What is spinal anesthesia?
Intraspinal anesthesia is one of the commonly used anesthesia methods, also known as semi anesthesia. Intraspinal anesthesia is the injection of anesthetic drugs into the subarachnoid or epidural space of the spinal canal, which blocks the nerve root and produces anesthetic effects in the corresponding area innervated by the nerve root.
According to the injection location, it can be divided into subarachnoid anesthesia (commonly known as spinal or lumbar anesthesia), epidural block, lumbar combined anesthesia, sacral block anesthesia, etc.
Intraspinal anesthesia is mainly used for surgeries in the lower abdomen, lower limbs, and anus. In clinical practice, lumbar anesthesia is generally performed by puncturing the gaps between lumbar vertebrae 2-3 and 3-4, while epidural anesthesia is performed by puncturing other gaps, which belongs to regional anesthesia, that is, staged anesthesia. Spinal anesthesia includes lumbar anesthesia, epidural anesthesia, and sacral anesthesia.
2、 Precautions for spinal anesthesia
Precautions for spinal anesthesia include the following: 1. Patients with coagulation dysfunction, shock, infection at the puncture site, abnormalities in the central nervous system, and inability to cooperate with anesthesiologists are not suitable for spinal anesthesia. When performing spinal anesthesia, patients should not move freely and should cooperate with the operation according to the instructions of the anesthesiologist. When there is any discomfort, it can be expressed in language, otherwise it is easy to damage blood vessels and nerves during the puncture process, and in severe cases, it can cause paraplegia. After the surgical anesthesia is completed, in order to prevent low intracranial pressure headache, the patient should lie flat on the pillow for six hours after surgery. If there is any discomfort, inform the doctor promptly for treatment.
3、 What should patients pay attention to after spinal anesthesia?
Firstly, postoperative patients should lie flat. After lumbar anesthesia, there will be a small puncture hole. When standing upright, it will increase the pressure in the spinal cord cavity, increase the chance of cerebrospinal fluid leakage, and easily cause postoperative headaches. Therefore, postoperative patients are required to lie flat for 6 to 8 hours.
Secondly, after oxygen inhalation and spinal anesthesia, the tissue plane has a significant impact on respiration, and the higher the plane, the greater the impact. When the sensation of obstruction reaches the chest level 4, the phrenic nerve and intercostal muscles are affected, resulting in insufficient ventilation. Therefore, postoperative oxygen therapy is beneficial for the recovery of the body.
Thirdly, fasting and spinal anesthesia can cause sensory and motor nerve blockade, leading to decreased gastrointestinal function and even paralysis. After surgery, it is necessary to wait for intestinal ventilation before eating, which usually takes 12 to 24 hours.
Fourthly, nausea and vomiting can be caused by factors such as vagus nerve hyperactivity, increased gastrointestinal motility, bile reflux into the stomach, and preoperative mental stress in patients with hypotension after spinal anesthesia. Symptoms are more likely to self heal within one to two days after surgery.
Fifth, for patients who are unable to move their lower body, spinal anesthesia should be blocked below the level of the spinal cord. If there is a feeling or movement paralysis in the lower body, there is no need to worry. Generally, it can recover on its own after 3 to 6 hours of drug metabolism after surgery.
Sixth, urinary retention. The parasympathetic nerve fibers that govern the urination reflex are very thin and sensitive to local anesthetics, so the skin sensation continues to exist after surgery, and usually returns to normal 6 hours after surgery.
Seventh, wake up slowly. After anesthesia, the blood vessels in the lower body dilate and venous blood accumulates. Therefore, sit for a period of time before getting up. Getting up quickly may cause dizziness and vertigo.
4、 Prevention and treatment of complications of spinal anesthesia
Nowadays, many surgeries require anesthesia to be performed. During anesthesia, spinal anesthesia is often used to achieve better results and longer duration.
At present, spinal anesthesia is one of the commonly used anesthesia methods in hospitals at all levels in China, especially in primary hospitals, mainly including subarachnoid space block, epidural block, and lumbar epidural block. Subarachnoid space block has a lower incidence of postoperative lower back pain due to the use of a 25G fine needle puncture, which causes less tissue damage. The incidence of lower back pain after epidural block is 2% to 31%, and some lower back pain after epidural block will transform into persistent lower back pain, causing great harm to patients and affecting their postoperative quality of life to varying degrees. Therefore, lower back pain caused by spinal anesthesia is receiving increasing attention. This article provides a review of the causes, diagnostic criteria, treatment methods, and prevention of lower back pain after spinal anesthesia, based on recent relevant literature.
5、 Will spinal anesthesia cause lower back pain?
At present, research suggests that the mechanism of lower back pain is mainly related to the following aspects: ① Mechanical compression: Protruding intervertebral disc tissue can cause lower back and leg pain in patients, and the presence, severity, and index of the protruding intervertebral disc are closely related to the symptoms of lower back and leg pain.
② Chemical radiculopathy: Degenerative changes in the intervertebral disc can cause glycoproteins, beta proteins, histamine, and other substances in the nucleus pulposus to enter the epidural space and surrounding nerve roots, causing local inflammatory reactions and leading to pain. Habtemariam et al. detected white blood cells, macrophages, and lymphocytes in the protruding intervertebral discs of experimental animals through in vivo experiments. Subsequently, a large number of studies gradually confirmed that phospholipase A2 (PLA2), metalloproteinases, nitric oxide, interleukin (IL-6), and prostaglandin E2 (PGE2) were also detected in the intervertebral disc tissue of patients.
③ Autoimmune function: In pathological conditions, when the fibrous ring ruptures or gaps appear, the nucleus pulposus comes into contact with the autoimmune system, forming an immune response that triggers an autoimmune response in the nucleus pulposus and surrounding tissues, leading to lower back pain in patients.
One of the main causes of lower back pain after spinal anesthesia is the inevitable invasive procedure. Although its pathogenesis shares some similarities with the non-specific lower back pain mentioned above, spinal anesthesia can further exacerbate existing lower back pain symptoms, indicating that lower back pain caused by spinal anesthesia has its own particularities.
The prevention and treatment of complications of spinal anesthesia have been specifically introduced above. Therefore, for some patients who undergo spinal anesthesia, it is necessary to understand the above content and what are the complications? How to prevent and deal with it, and then carry out targeted prevention and treatment, so as to make oneself healthier and have a higher quality of life.