uncommon and usually clear up quickly. They can include lower
extremity pain or headache, which could be accompanied by double
vision, especially in younger patients. You'll want to ask patients if
they have experienced any of these issues when making follow-up
calls the day after surgery.
Patient selection and assessment, including a history and physical
examination of the injection site, is critical for successful use of spinal
anesthesia and avoidance of complications due to contraindications.
"As always, clinical care needs to be individualized," says Dr. Aziz.
"That said, I think there's a lot of utility in some standardization,
adhering to set pathways that are associated with reduced complica-
tions. There's a benefit to setting up a primary pathway for a host of
surgical procedures, and I think spinal anesthesia has a clear home in
that."
The better option
When spinal anesthesia is administered, the needle passes through
the epidural space into the subarachnoid space, where the cere-
brospinal fluid resides. It takes effect much more quickly than an
epidural — usually three to five minutes. Spinal is a home run for
lower extremity, lower abdominal, pelvic and perineal procedures.
Spinal immobilizes and desensitizes everything below the injection
site, but the block wears off quickly, and bladder function and mobili-
ty are rapidly restored. Side effects are few — a slight headache is
the most commonly reported one. All of this is perfect for outpatient
surgery.
OSM
Managing Editor Jared Bilski contributed reporting to this story.
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