Pediatric Spinal Anesthesia: An Alternative to “Going Under”
Apr 23, 2024
Spinal anesthesia or a “spinal” is an alternative to general anesthesia, which allows your child to undergo their surgery without being put into a drug-induced sleep. Babies and toddlers can have a “spinal” performed prior to surgery, which will make them numb from their belly down. This will allow the surgery to be performed without giving anesthesia gas or placement of a breathing tube. This type of anesthesia typically lasts around 90 minutes.
What are the benefits of spinal anesthesia compared to general anesthesia?
With spinal anesthesia, there is no need to place a breathing tube or administer anesthesia gas to the patient. This technique decreases the chances of your child experiencing issues with oxygenation, blood pressure changes, allergic reactions, or neurological risks that may be associated with prolonged or repeated exposure to general anesthesia. There is also no risk of postoperative nausea or vomiting. Patients who have spinal anesthesia are usually able to reunite with their parents or caregivers immediately following surgery without going to the “recovery room” first.
What are the risks of spinal anesthesia?
Like all medical interventions, this anesthesia technique carries potential risks for your child. These risks include bleeding, infection, nerve damage, and failed surgical block. To minimize these risks, we perform this procedure using sterile precautions, and the procedure will be performed or supervised by one of our board-certified pediatric anesthesiologists with experience in spinal anesthesia. Permanent nerve damage is an exceedingly rare complication in this population. If the spinal “fails,” we are able to change to general anesthesia seamlessly as a back-up plan.
What patients are candidates?
This technique is performed mostly for patients aged 18 months and below who are having the following types of surgeries:
Urological surgery including circumcision, hypospadias repair, orchiopexy
Cystoscopy
Hernia repair
Achilles tenotomy/lengthening
Other procedures on the abdomen or lower extremities
Spinal anesthesia is not an option for surgeries or procedures that are expected to last longer than 90 minutes. Patients that have differences in vertebral anatomy, bleeding disorders, or active infection may not qualify for spinal anesthesia.
What will the “day of surgery” look like?
On the day of surgery, you will bring your child for preoperative assessment by one of our anesthesiologists. The restriction times for eating and drinking before surgery are the same for both general and spinal anesthesia. If spinal anesthesia is to be performed, a numbing ointment will be placed over the child’s lower back in the preoperative area to numb the skin prior to the needle insertion.
The anesthesiologist will perform the spinal in the operating room before the surgery begins, and an IV catheter will be placed in the foot after the legs have become numb from the spinal block. The spinal anesthesia has a natural sedating effect and patients will usually fall asleep during surgery by themselves or with a pacifier and gentle music. After surgery, you will typically be immediately reunited with your child without waiting for recovery from anesthesia. It is normal for the child’s legs to remain weak or numb for up to an hour postoperatively. Recovery times are consistently shorter compared to general anesthesia recovery times.
If you are interested in this type of anesthesia, please do not hesitate to have a discussion with your surgical team. Our goal is to provide the safest and most favorable anesthetic experience to you and your child.
Giorgio Veneziano, MD, FAAP, is the medical director of the Comprehensive Pain Services at Nationwide Children’s Hospital and Associate Professor of Clinical Anesthesiology and Pain Medicine at The Ohio State University College of Medicine.
Grant J. Heydinger, MD
Grant J. Heydinger, MD
Dr. Heydinger is on the Anesthesiology & Pain Medicine Physician Team at Nationwide Children's Hospital.
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