The term spinal anesthesia refers to three types of anesthesia depending on how the anesthesia is applied. The effect is basically the same. An epidural block is usually used during labor while a spinal block is usually used for a cesarean delivery. SPEDA is a combination of spinal and epidural anesthesia and is not that common today.
When administering an epidural block, a local anesthetic and an opioid is injected through a narrow catheter in the lumbar epidural space between two vertebrae. The result is a sensory nerve block. The anesthetic can be administered at regular intervals throughout labor in the form of a pump or with the help of bolus doses. Nerve impulses that transmit the pain from the uterus to the brain are blocked.
When administering a spinal block, the anesthetic is injected directly into the spinal canal.
Today, spinal blocks are considered to be the most efficient way to numb the pain during labor. The woman, the baby and the contractions must be constantly monitored using a fetal monitoring unit when using these types of anesthetics. An IV will be inserted into the woman’s hand or arm through which she will receive a saline solution to prevent a drop in blood pressure.
Technique
The block is administered by an anesthesiologist as follows:
- To ensure that there is as much room as possible between the vertebrae, the woman lies or sits with her chin bent toward her chest and her legs pulled up toward her tummy
- The area where the needle will be inserted is sterilized and a local anesthetic is applied
- The cannula is inserted and, although not generally painful, can be uncomfortable
- When an epidural block is administered, the thin plastic tube is put in place
- The cannula is removed, and the plastic tube fixed in place
- A trial dose is injected to ensure that the catheter is properly positioned, and the main dose is administered about five minutes later
It takes between 15 and 20 minutes to achieve full effect of a spinal block, and the effect lasts for about two hours. If a pump is connected to the epidural tube, the anesthetic and opioid is administered constantly, or the midwife administers more as needed.
Spinal block advantages
- Good pain relief for a long period of time
- No mental effect
Spinal block disadvantages
- The woman may experience reduced mobility in the legs, there is a risk of a drop in blood pressure, chills and itching from the injected medication
- There is a risk that contractions will weaken, requiring contraction-stimulating medication
- In groups where the women received a spinal block, it is more common that the use of a traction cup is necessary
- The woman can develop problems urinating. There is also a risk of back pain after where the block was administered and severe headaches
Sources:
- Abascal, G., & Huss, M. S. (2018). Att föda. Bonnier Fakta.