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.
1、 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. 2. 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. 3. 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.
2. Prevention and treatment of complications of spinal anesthesia
3. Nowadays, many surgeries must be performed through anesthesia. During anesthesia, spinal anesthesia is often used to achieve better results and longer duration. So, what are the prevention and treatment of complications of spinal anesthesia?
2、 Prevention and treatment of lower back pain after spinal anesthesia
Currently, spinal anesthesia is one of the commonly used anesthesia methods in hospitals at all levels in China, especially in primary hospitals. It mainly includes subarachnoid 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.
3、 Does spinal anesthesia have an impact on postoperative lower back pain?
Firstly, we need to understand the pathogenesis of lower back pain under spinal anesthesia. Currently, 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 size of lower back and leg pain symptoms are closely related to the index of the protruding intervertebral disc.
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. 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. This 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.
4、 The causes of postoperative lower back pain
Intraspinal anesthesia, including lumbar or epidural anesthesia, is a common anesthesia technique that is achieved through lumbar puncture. This anesthesia method may cause some degree of damage to the soft tissues of the lumbar spine, although these injuries are usually mild. After surgery, some patients may experience lower back pain, which is usually caused by minor damage to soft tissue during the puncture process. In addition, pregnant women may experience additional pressure on their spine during pregnancy, leading to minor injuries to the muscles in the back of the spine. Re trauma to the body during anesthesia may exacerbate postoperative pain. The postoperative back pain of postpartum women may also be related to factors such as confinement, lateral breastfeeding, and weight changes, which may lead to insufficient repair of back muscles and ligaments.
5、 Preventive and relief measures
In order to reduce postoperative back pain, patients need to rest in a supine position for 1-2 weeks after surgery, avoiding excessive use of lumbar muscles to promote recovery from puncture trauma. Appropriate hot compress and stretching exercises can help restore back muscle function and reduce pain. In addition, selecting appropriate anesthesia techniques and puncture methods may also affect the incidence of postoperative back pain. For example, compared with the direct approach, the lateral approach of spinal anesthesia can reduce the incidence of postoperative lower back pain in patients.
6、 Research findings
Some studies indicate that the impact of spinal anesthesia on postoperative lower back pain varies among individuals. Some patients may experience lower back pain after surgery, but this pain can usually be relieved through rest and simple treatment methods. In some cases, lower back pain may be related to the surgery itself or other factors, rather than just the result of anesthesia procedures.
7、 Overall, spinal anesthesia may cause some patients to experience lower back pain after surgery, but this pain is usually temporary and can be relieved through appropriate care and treatment. If you experience persistent lower back pain after surgery, it is recommended to seek medical attention promptly for proper diagnosis and treatment. 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.