spinal or epidural, is there a difference?

Hello sisters,

I'm wondering if it just a language confusion or is there a difference between a spinal tap and an epidural? My pre-op appointment is on Jan 26 and don't want to sound like a fool asking my good dr. this question. Many of your posts have mentioned one or the other. So what's what?

You've actually got three different things going there.

A spinal *block*, and an epidural, are similar, but not quite the same (more on that in a minute).

A spinal *tap* is a painful diagnostic procedure used to draw spinal fluid for analysis.

When my anesthesiologist first suggested a "spinal", which I had not heard about before, I asked him if it would include any screaming in terror. He said he certainly hoped not! (And it didn't.)

A spinal *block* (mostly just called "a spinal") introduces drugs into the area near the spinal cord, and (as the name suggests) blocks sensation and movement below that point. It's usually a mix of drugs, including a long-lasting pain killer (morphine, in my case). It allows about 90 minutes for the surgery - during that time you can't feel a darned thing, and can't move. Then for the next 18-24 hours you can move and feel, but the pain is very well controlled.

A spinal is given as one shot - you roll on your side, or sit, hunched over, and get a little shot in your back. Mine felt about like having blood drawn - just a little stick, not bad.

A spinal only lasts so long, so for complicated surgeries, or those where the doctor isn't sure what they'll find, it might not be the best choice. If you did have a spinal, then the doctor found out things were going to take longer than expected, they'd just switch to a general. No biggie.

An epidural works on the same principle, but the drugs are introduced continuously through a tiny tube (instead of in one shot). The cool thing about an epidural is that they can keep the drugs going for as long as needed, and afterward they can hook you to a PCA (Patient Controlled Anesthesia) device so *you* can give yourself more drugs, as needed.

Sometimes these are used in combination with a general. So you could have your surgery done with general anesthesia, then get a spinal or epidural for pain control for the first day or so.

Hi Chellenme, :hiya:

Yep, horsewoman got it all. I just want to add my . With the "spinal" you will be kept on spinal precautions for a number of hours after you arrive in your room. These include laying flat (no rolling and only a very flat pillow) until you can feel all sensation up to your waist. A word of caution (I am an RN), if they tell you to keep your head down - do it - spinal headaches can be the result of sitting up too soon after a spinal. And believe me, you DO NOT want one of them. They will also check the little bandage (that's all you'll have) over the spinal injection site to be sure of no spinal leaks - another cause of those nasty headaches.

I don't mean to scare you - just inform you. Many, many of my patients have had spinals and not a complication amoung them. The epidural route is another good way to go. There are many, many good pain control/anesthesia choises. And NO question should every be held back during your pre-op - ask anything you want - they are never "foolish".

Best wishes to you on your upcomming surgery. Let us know how you make out.

Have a blessed holiday season.
Melissa

One other difference - you don't have to lay flat with the epidural. I had a three hr. hysterectomy with and epidural and sedation, and did just great. The morphine was administered through the epidural, so there were no stomach problems. I was up and walking the next day.

I have back problems, and don't get along very well with general anesthesia, so this was the route I took, and it worked great for me.

Lots of luck - and let us know how it's going!

Mindy

I had a spinal for my total knee surgery cause the doc likes them and he uses them all the time for that surgery. It was a weird feeling but I was more awake after the surgery than I have been after a general. I always feel like I am in a after a general. When I had my hyst, the doc didn't want to go that route cause he didn't know what all he would find inside me when he cut me open and so he put me to sleep. But with my PCA with morphine and my IV having phenergan I didn't have a bit of pain after my surgery. Plus I got Toradol every 6 hours until I left also. I was pretty sedated the whole time that I was there...in fact they had to take the phenergan IV off cause I couldn't stay awake for anything. I would wake up, think that I would need to turn, give myself a shot and then go back to sleep. Then I would wake up in an hour and do the whole thing over. I was a space puppy in the hospital.

I guess it used to be that you had to lie still, on your back, for what, 12-24 hours (not sure???) after a spinal. But you don't have to lay flat with a spinal anymore. I was free to move (roll) around as soon as I was able (within an hour, in recovery).

Good Day Ladies!!!
I will stand on my soapbox once again to endorse spinals.....Given the choice between general and spinal...spinal takes the cake.....I had general with a knee surgery and was sicker than a dog minutes after....wicked headache for days after.....With the spinal I had for my TVH....wide awake within minutes after surgery and yacking like usual (making sense too)....no headache....just numb for a while...gave me and the recovery room nurse a chance to chat....
I did stay in bed that day and night but it wasn't from the spinal....my DR likes the surgery site to start healing together before she lets you out of bed??? Whatever...it worked wonderfully.....I questioned the A guys preop about an epidural vs. spinal....he said that with an epidural they are not guaranteed a solid "frozen" area....which meant some spots of your pelvis could be not frozen for them to do surgery...ouch!!!!! He said epidurals are great for taking the "edge" off labor pains but they preferred not to use them for surgery.....Okay with me...They just gave me some Versed before they did the spinal and I didn't even feel the stick in my back.....just floated during surgery...mostly out of it...but no overwhelming pain at all during the whole recovery procedure....they gave me a Demerol PCA and it did a great job.....did have a slight wave of nausea when I got to my room...but IV Zofran took care of that and was eating lunch a little while later.....
Good luck and remember we are all here for you!!!

lilly

A big group to all my wonderful sisters for replying to my post. Your encouragement and personal stories have really bolstered my decision to ask for a spinal (now that I know the difference).

Still 60 days to go but can do that in a heartbeat. The wait for a date was the worst part. Will update you once I'm a Princess and I'll still be popping by before then.

You are my s

God Bless you all.