What is spinal anesthesia nerve damage

Deep nerve injury caused by intrathecal anesthesia refers to the injection of anesthetic drugs into the subarachnoid space or subdural space of the spinal canal to produce an anesthetic effect. This is generally called intrathecal anesthesia. If the injection site is different, it is divided into subarachnoid anesthesia, combined spinal-epidural anesthesia, etc. During such anesthesia, if the operation is improper, it may cause certain nerve damage.

Indications

1. Subarachnoid anesthesia

It is mostly suitable for surgical anesthesia of the lower abdomen, lower limbs and perineum within 2 to 3 hours, such as lower limb surgery, hemorrhoidectomy, cesarean section, etc.

2. Epidural block

It can be used for various surgeries on the abdomen, waist, pelvis and lower limbs, as well as superficial surgeries on the neck, upper limbs and chest wall. Epidural anesthesia can be used for all surgeries that are suitable for spinal anesthesia. Epidural block is also used clinically as an auxiliary treatment for coronary heart disease, vascular occlusive disease, herpes zoster, and painless childbirth.

Contraindications

1. Subarachnoid anesthesia

Central nervous system diseases such as multiple sclerosis of the spinal cord, meningitis, spinal deformity and trauma, spinal tuberculosis and tumors, shock, sepsis, skin infection near the puncture site, and coagulation dysfunction are considered contraindications to spinal anesthesia, and patients with coronary heart disease should use it with caution.

2. Epidural block

Similar to subarachnoid anesthesia, central nervous system diseases such as meningitis, spinal deformity and trauma, spinal tuberculosis and tumor, shock, sepsis, skin infection near the puncture site, coagulation dysfunction, etc. are all considered contraindications. Patients with clinical dyspnea should not use cervical and thoracic epidural anesthesia. Women who are menstruating or patients who are taking anticoagulants such as aspirin should not use this anesthesia because it affects coagulation function.

Anesthesia Technique

Generally, the patient is placed in the side-lying or sitting position (saddle block), with the back perpendicular to the bed surface and flush with the edge of the bed, and the waist is bent backward as much as possible to open the interspinous process space for puncture. Taking spinal anesthesia as an example, the L3-4 or L2-3 space is generally used.

First locate the area, then infiltrate anesthesia layer by layer in the skin, subcutaneous tissue and interspinous ligament to reduce the pain of puncture. Direct or lateral puncture is selected according to the condition of the patient and the anesthesiologist's habits. The sign of a successful puncture is the outflow of cerebrospinal fluid, followed by the injection of anesthetics into the subarachnoid space. In clinical practice, the block plane is often tested by skin pain test or cold saline cotton swab to adjust the anesthesia level.

Block plane regulation is an important part of subarachnoid block anesthesia. In a very short time, the plane can be controlled within the range required for surgery. There are many factors that affect the plane, such as the height of the puncture gap, the patient's height and weight, body position, type, concentration, dosage, volume and specific gravity of local anesthetics, as well as the bevel direction of the needle tip and injection speed. Therefore, after a successful puncture, anesthesiologists often quickly ask patients to cooperate, measure the sensory plane, adjust body position and block plane to achieve a perfect anesthesia effect.