The Spinal Anesthetic

Orthopedic anesthesia is a great rotation to learn the spinal anesthetic, shown above. The spinal is pretty much the same as a lumbar puncture; a long needle is placed into the low back to access the spinal or subarachnoid space. In a lumbar puncture, fluid is taken out and tested for meningitis or other diseases. In a spinal, local anesthetic or opiate is injected to numb the nerves supplying the legs. Many people are afraid of the "spinal tap," and from the outside, it feels like a terrifying procedure. People are afraid of the spine, cannot see the needle going in, and have to maintain an uncomfortable position. But from a medical standpoint, the LP or spinal anesthetic is one of the more minor procedures where the risks are far lower than the benefits.

I offered a spinal anesthetic for all my hip and knee joint replacements. With total knees, a spinal anesthetic numbs the legs so that the patient does not need a general anesthetic; the case is instead done under deep sedation. With total hips, the patient still receives a general, but the post-operative pain and overall opiate consumption is much less with a spinal. Indeed, the difference between two patients, one who elected for a spinal and one who didn't, was remarkable; it's amazing to be able to wake someone up from surgery and have them be completely comfortable.

Learning the spinal was a good experience. I'd done LPs in the past, but these are different because in the operating room, there's always time pressure. I didn't have time to dilly-dally, and I had to be confident of my movements. But over the course of the last two weeks, I really became comfortable with the procedure, planning everything in advance, understanding exactly how things felt, and knowing when I was in the right space. I'm starting to feel like an anesthesiologist.

Image of spinal anesthetic shown under Creative Commons Attribution Share-Alike License, from Wikipedia