Neuraxial Anesthesia - Types, Uses, and Side Effects

Introduction:

Anesthesia is used in surgeries to control pain. Anesthesia is of different types and is delivered in different modes to the patient. General, local, and regional anesthesia and sedation are the four types of anesthesia. Under regional anesthesia, many significant surgeries are performed, like cesarean section. Neuraxial anesthesia is a kind of regional anesthesia. This topic explains neuraxial anesthesia, its types, usage, and side effects.

What Is Neuraxial Anesthesia?

Neuraxial anesthesia is a type of regional anesthesia that involves an injection in the surrounding nerve roots present in the spine. It consists of the spine's epidural space and the spinal sac containing cerebrospinal fluid around the spinal cord. Neuraxial anesthesia numbs the area below the injection site covering the lower abdomen and the legs.

What Is Regional Anesthesia?

Regional anesthesia is a type of anesthesia used to numb the more significant body parts. It blocks the nerve signals going to the brain from the targeted surgical site and controls the pain during surgical procedures. Under regional anesthesia, many major surgical procedures can be performed, like cesarean sections and knee surgeries. In addition, the neuraxial is a part of regional anesthesia.

What Are the Types of Neuraxial Anesthesia?

There are four types of most commonly used neuraxial anesthesia. They are as follows:

1. Spinal Anesthesia - Anesthesia is delivered in the spinal sac, which can block the spine's nerves surrounding the spinal cord. Spinal anesthesia injection is given deep, crossing the skin, subcutaneous fat layer, ligaments, and epidural space and reaching the spinal sac containing cerebrospinal fluid and spinal cord. It is used to numb the lower abdomen as it is given at the lumbar area of the backbone.

2. Epidural Anesthesia - Anesthesia is delivered in epidural space, where it blocks the nerves exiting the spine. Epidural anesthesia is also given deep but one layer behind spinal anesthesia. It crosses the skin, fat layers, ligaments, and epidural space. Epidural space has nerves that leave the spinal column; anesthesia medicine numbs these nerves and blocks their pain sensations. It is given to numb the lower abdomen and the legs.

3. Combined Spinal-Epidural Anesthesia - Combined spinal-epidural anesthesia is used as it provides better results than individually administered spinal or epidural anesthesia. The combined form provides rapid onset and more effective results. Instead of using a single injection, it employs a single spinal anesthetic shot, followed by an epidural anesthetic delivered via catheter for use during subsequent procedures or as a postoperative painkiller. It numbs the lower abdomen, lower back, and legs but with more effectiveness.

4. Caudal Anesthesia - Anesthesia is delivered at the caudal epidural site (the tailbone of the spine). It is delivered in epidural space but in the tailbone (a small bone at the bottom of the spine). It is used to numb the areas of the leg and pelvis.

What Are the Uses of Neuraxial Anesthesia?

The uses of neuraxial anesthesia are:

• Obstetric Surgery - Obstetrics is a branch that deals in the pregnancy, delivery, and post-delivery period. It includes-

• Cesarean Surgery - It is done to deliver the baby by incision, not vaginally.

• Hysterectomy - It is a procedure to remove the womb of a woman.

• Tubectomy - It is the procedure to block the fallopian tubes for permanent contraception.

• Cervical Surgery - It is a surgical procedure on the cervix of the woman, the upper part of the vagina.

• Ovarian Surgeries - It is a surgical procedure to remove one of the ovaries.

• Tuboplasty - It is the surgical repair of fallopian tubes.

• Myomectomy - It is a surgical procedure to remove fibroids from the uterus

• Non-Obstetric Surgery - Non-obstetric surgery is surgery excluding the obstetric branch (delivery or postpartum or pregnancy period). It includes-

• Orthopedic surgery of lower limbs and pelvis involves hip fracture and knee replacement.

• General surgery involves appendix, hernia, and testis surgeries.

• Urological surgeries include bladder, stone in the ureter, and prostate surgery.

• Surgeries of the upper abdomen.

• As postsurgical analgesia, the medicine is delivered after the surgery to relieve the pain occurring after the surgery.

• Caudal anesthesia can be used in children for surgeries on the lower abdomen.

What Are the Side Effects of Neuraxial Anesthesia?

Side effects of neuraxial anesthesia are:

• Infection.

• Bleeding.

• A sudden drop in blood pressure.

• Severe headache.

• Nausea.

• Itchiness on the skin.

• Dizziness.

• Allergic reaction.

• Urinary retention.

• Fever.

• Shivering.

• Breathing problems.

• Seizures.

• Spinal cord damage.

• Nerve injury.

• Cardiac arrest.

What Are the Anesthetic Agents Used in Neuraxial Anesthesia?

Anesthetic agents that are commonly used in neuraxial anesthesia are:

• Lidocaine.

• Bupivacaine.

• Ropivacaine.

• Levobupivacaine.

What Are the Contraindications to Neuraxial Anesthesia?

Contraindications to neuraxial anesthesia are:

• Allergy to anesthetic drugs.

• Localized infection.

• Any previous spinal cord injury present, like spinal stenosis (narrowing of the spinal cord).

• When the patient refuses to go for it.

• The patient takes anticoagulants, which stop blood clots from forming.

What Is the Difference Between Regional and Neuraxial Anesthesia?

Regional anesthesia is used to numb the large body area, like the entire arm or leg, whereas neuraxial anesthesia is delivered only in the spinal area involving the spine. Neuraxial is a part of regional anesthesia. The neuraxial also numbs the legs and lower abdomen.

Can Neuraxial Be Performed in Child Patients?

Yes, neuraxial anesthesia can be performed in child patients also. Caudal anesthesia is mainly used in child patients for pelvic surgeries. Caudal anesthesia can be used with general anesthesia in child patients.

Is Combined Spinal-Epidural Anesthesia Better Than Individually Used Spinal or Epidural Anesthesia?

Yes, combined spinal-epidurals are better than individual use of spinal or epidurals. Combined spinal-epidural anesthesia is advantageous as it provides rapid onset with better pain suppression. In addition, the amount of medicine (anesthesia) used affects the baby and the patient's body less. Using individual spinal or epidural is not as effective as the combination.

Conclusion:

Neuraxial anesthesia is a kind of regional anesthesia used to inject anesthesia into the spinal area of the spine. It is used to numb the area of the spine. It has four types; epidural, spinal, combined spinal-epidural, and caudal anesthesia. It is commonly used in cesarean sections. Other uses of neuraxial anesthesia include postsurgical analgesia, orthopedic surgery, obstetric surgery, and urological surgeries. Neuraxial anesthesia side effects and contraindications are mentioned in the above topic.